• Valeria Cento, Luna Colagrossi, Irene Bossi, Daniele Armenia, Alice Nava, Enrico Piccinelli, Alessandro Maloberti, Elvira Inglese, Elisa Matarazzo, Federica DI Ruscio, Pierpaolo Paba, Fabbio Marcuccilli, Marco Perrone, Gaetano Chiricolo, Claudia Alteri, Francesco Scaglione, Chiara Vismara, Daniela A Campisi, Diana Fanti, Francesco Romeo, Massimo Andreoni, Fabrizio Oliva, Francesca Ceccherini-Silberstein, Cristina Giannattasio, and Carlo F Perno.
• Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy - valeria.cento@unimi.it.
• Minerva Med. 2023 Jun 1; 114 (3): 289299289-299.

BackgroundAcute coronary syndromes (ACS) are a major cause of morbidity and mortality. As cytomegalovirus (CMV) may contribute to cardio-vascular (CV) manifestations, we sought to provide a proof-of-concept for the involvement of coronary and/or systemic CMV-reactivation as a possible ACS trigger.MethodsWe prospectively enrolled consecutive patients undergoing a coronary angiography for ACS (acute-cases, N.=136), or non-ACS reasons (chronic-cases, N.=57). Matched coronary and peripheral blood-samples were processed for quantification of CMV-DNAemia (RT-PCR), CMV-IgG/IgM, and CMV-IgG avidity (ELISA). Peripheral-blood samples from 17 healthy subjects were included as controls.ResultsOut of the 193 cases included, 18.1% were aged ≤55 years, 92.5% were Central-European, and 100% immunocompetent. CMV-IgG seroprevalence was 91.7% (95%CI: 87.8-95.6), significantly higher than in healthy-controls (52.9% [95%CI: 29.2-76.5]; P<0.001), yet consistent across age-groups (P=0.602), male/females (P=0.765), and acute/chronic-cases (P=0.157). Median (IQR) IgG titers were 110 (84-163) AU/mL, with 0.62 (0.52-0.72) avidity, supporting a long history of infection. No acute CMV infections were found. In 22.6% (n/N.=40/177) of the IgG-positive cases low-level coronary and/or systemic CMV-DNAemia (always <40 copies/mL) was detected. While no differences in peripheral CMV-DNAemia prevalence were observed nor among cases nor controls, coronary CMV-DNAemia was more frequent in acute-cases without modifiable CV risk-factors (n/N.=4/10; 40.0%), than in chronic-cases (n/N.=6/55, 10.9%; P=0.029), or acute-cases with risk-factors (n/N.=16/112, 14.3%; P=0.058).ConclusionsCMV-IgG seroprevalence was high in patients with heart diseases. CMV-DNAemia can be found, although uncommonly, in coronary circulation during an ACS, with increased prevalence in older subjects and in absence of CV risk-factors, identifying possible areas for novel interventions.

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