This study demonstrates a high prevalence of CVB antibody positivity among patients with cardiac sarcoidosis, suggesting that CVB serology may represent a low-cost screening biomarker to help identify patients who may benefit from further evaluation with advanced cardiac imaging.
Key Findings
Results
The vast majority of cardiac sarcoidosis patients tested positive for coxsackievirus B antibodies.
51 of 56 patients (91%) with confirmed cardiac sarcoidosis demonstrated CVB antibody positivity
80% of patients exhibited moderate or high CVB antibody titres
The study included patients ≥18 years who met Heart Rhythm Society or Japanese Circulation Society criteria for probable or definite cardiac sarcoidosis
Data were collected from the University of Kansas Health System between 2011 and 2025
Results
CVB seropositivity in the cardiac sarcoidosis cohort was markedly higher than in external comparator populations.
CVB positivity was 91% in the cardiac sarcoidosis cohort compared to 14.5% in an external comparator cohort population
The external comparator populations included participants from the MAVERIC registry and previously reported population-based studies
This comparison suggests a substantially elevated rate of CVB exposure or infection among cardiac sarcoidosis patients relative to the general population
Results
Advanced cardiac imaging revealed frequent abnormalities consistent with cardiac involvement in the study cohort.
Delayed gadolinium enhancement on cardiac MRI was present in 78% of patients
Myocardial 18-fluorodeoxyglucose uptake on positron emission tomography (PET) was observed in 87% of patients
These findings were described as 'consistent with cardiac involvement'
Results
Conventional screening tests demonstrated limited sensitivity for detecting cardiac sarcoidosis.
Abnormalities on ECG, echocardiography, and ambulatory monitoring were observed in only a minority of patients
This finding highlights the inadequacy of standard cardiac screening tools for identifying cardiac sarcoidosis
The authors contrast this limited sensitivity with the high detection rate achieved by advanced imaging modalities such as cardiac MRI and PET
Methods
The study was a retrospective observational cohort design with a relatively small sample size.
A total of 56 patients with confirmed cardiac sarcoidosis were included
The study was conducted at a single center, the University of Kansas Health System
The retrospective design and use of an external rather than internal comparator cohort are noted limitations
CVB antibody titres and clinical data were extracted from the electronic medical record
What This Means
This research suggests that a virus called coxsackievirus B (CVB) may be closely linked to cardiac sarcoidosis, a serious condition in which the immune system forms inflammatory tissue clusters in the heart. The researchers looked at 56 patients diagnosed with cardiac sarcoidosis and found that 91% had detectable antibodies to CVB in their blood, and 80% had moderate to high levels of those antibodies. By comparison, only about 14.5% of people in general population comparison groups tested positive for CVB antibodies. This striking difference raises the possibility that CVB infection could play a role in triggering or contributing to cardiac sarcoidosis in some patients.
The study also found that standard heart tests like ECGs, echocardiograms, and heart monitors only picked up abnormalities in a minority of patients, suggesting these tools are often insufficient for detecting cardiac sarcoidosis early. In contrast, more advanced imaging — MRI scans showing delayed gadolinium enhancement (found in 78% of patients) and PET scans showing abnormal glucose uptake in the heart (found in 87% of patients) — were much more effective at revealing disease. This highlights a diagnostic gap where patients may go undetected by routine testing.
This research suggests that testing for CVB antibodies, which is a relatively simple and inexpensive blood test, might serve as a useful early warning signal to identify sarcoidosis patients who could have cardiac involvement and who might benefit from more advanced imaging. Because cardiac sarcoidosis is frequently underdiagnosed and can be life-threatening, finding accessible biomarkers to flag at-risk patients earlier could be clinically meaningful. However, since this was a small, single-center retrospective study, larger and more rigorous research is needed to confirm these findings and determine whether CVB plays a causal role.
Donnelly K, Wilmoth J, Osborne W, Heavens J, Haworth S, Pandya S, et al.. (2026). High prevalence of coxsackievirus B antibodies in patients with cardiac sarcoidosis: a retrospective cohort study.. Open heart. https://doi.org/10.1136/openhrt-2026-004431