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Evaluation of Cardiac Involvement in Children with Dengue by Serial Echocardiographic Studies.

Kirawittaya T, Yoon IK, Wichit S, Green S, Ennis FA, Gibbons RV, Thomas SJ, Rothman AL, Kalayanarooj S, Srikiatkhachorn A - PLoS Negl Trop Dis (2015)

Bottom Line: Cardiac dysfunction was transient and did not require treatment.Transient elevated troponin-T levels were more common in DHF cases compared to DF (14.5% vs 5%, p = 0.028).Cardiac structural changes including myocarditis were uncommon.

View Article: PubMed Central - PubMed

Affiliation: Queen Sirikit National Institute of Child Health, Bangkok, Thailand.

ABSTRACT

Background: Infection with dengue virus results in a wide range of clinical manifestations from dengue fever (DF), a self-limited febrile illness, to dengue hemorrhagic fever (DHF) which is characterized by plasma leakage and bleeding tendency. Although cardiac involvement has been reported in dengue, the incidence and the extent of cardiac involvement are not well defined.

Methods and principal findings: We characterized the incidence and changes in cardiac function in a prospective in-patient cohort of suspected dengue cases by serial echocardiography. Plasma leakage was detected by serial chest and abdominal ultrasonography. Daily cardiac troponin-T levels were measured. One hundred and eighty one dengue cases were enrolled. On the day of enrollment, dengue cases that already developed plasma leakage had lower cardiac index (2695 (127) vs 3188 (75) (L/min/m2), p = .003) and higher left ventricular myocardial performance index (.413 (.021) vs .328 (.026), p = .021) and systemic vascular resistance (2478 (184) vs 1820 (133) (dynes·s/cm5), p = .005) compared to those without plasma leakage. Early diastolic wall motion of the left ventricle was decreased in dengue cases with plasma leakage compared to those without. Decreased left ventricular wall motility was more common in dengue patients compared to non-dengue cases particularly in cases with plasma leakage. Differences in cardiac function between DF and DHF were most pronounced around the time of plasma leakage. Cardiac dysfunction was transient and did not require treatment. Transient elevated troponin-T levels were more common in DHF cases compared to DF (14.5% vs 5%, p = 0.028).

Conclusions: Transient left ventricular systolic and diastolic dysfunction was common in children hospitalized with dengue and related to severity of plasma leakage. The functional abnormality spontaneously resolved without specific treatment. Cardiac structural changes including myocarditis were uncommon.

No MeSH data available.


Related in: MedlinePlus

Hemodynamic status and plasma leakage in dengue by fever day.Heart rate (A), systolic blood pressure (B), diastolic blood pressure (C), inferior vena cava diameter (D), mean cardiac index (E), systemic vascular resistance (F), frequencies of cases with a pleural effusion or ascites (G), and daily fluid intake (H) of dengue fever (dotted line) and dengue hemorrhagic fever cases (solid line) over the course of the illness. Fever day 0 denotes day of defervescence. * different from dengue fever cases (P < .05). The numbers of cases were: fever-day -3 (DF 4, DHF 5), fever-day-2 (DF 13, DHF 9), fever-day-1(DF 43, DHF 26), fever-day-0(DF 104, DHF 56), fever-day+1(DF 119, DHF 62), fever-day+2(DF 70, DHF 60), fever-day+3(DF 13, DHF 38).
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pntd.0003943.g001: Hemodynamic status and plasma leakage in dengue by fever day.Heart rate (A), systolic blood pressure (B), diastolic blood pressure (C), inferior vena cava diameter (D), mean cardiac index (E), systemic vascular resistance (F), frequencies of cases with a pleural effusion or ascites (G), and daily fluid intake (H) of dengue fever (dotted line) and dengue hemorrhagic fever cases (solid line) over the course of the illness. Fever day 0 denotes day of defervescence. * different from dengue fever cases (P < .05). The numbers of cases were: fever-day -3 (DF 4, DHF 5), fever-day-2 (DF 13, DHF 9), fever-day-1(DF 43, DHF 26), fever-day-0(DF 104, DHF 56), fever-day+1(DF 119, DHF 62), fever-day+2(DF 70, DHF 60), fever-day+3(DF 13, DHF 38).

Mentions: Fig 1 shows the patterns of hemodynamic and volume indices and fluid intake over the course of the illness of DF and DHF cases. DHF cases had higher heart rate compared to DF early in the course of illness and this persisted throughout the acute illness (A). There was no difference in systolic blood pressure (B), but mean diastolic pressures were higher in DHF cases around the day of fever resolution (fever day 0) and shortly thereafter (C). This coincided with decreased intravascular volume as indicated by a decrease in the average IVC diameter in DHF cases (D). DHF cases had lower CI (E) at defervescence (fever day 0) and increased SVR (F) on fever day 0 and +1 compared to DF cases. Ultrasonography revealed a gradual increase in the percentage of cases with plasma leakage, with peak incidence on fever day +1 (G). Patients with DHF also received more fluid compared to those with DF starting on fever day 0 and afterward.


Evaluation of Cardiac Involvement in Children with Dengue by Serial Echocardiographic Studies.

Kirawittaya T, Yoon IK, Wichit S, Green S, Ennis FA, Gibbons RV, Thomas SJ, Rothman AL, Kalayanarooj S, Srikiatkhachorn A - PLoS Negl Trop Dis (2015)

Hemodynamic status and plasma leakage in dengue by fever day.Heart rate (A), systolic blood pressure (B), diastolic blood pressure (C), inferior vena cava diameter (D), mean cardiac index (E), systemic vascular resistance (F), frequencies of cases with a pleural effusion or ascites (G), and daily fluid intake (H) of dengue fever (dotted line) and dengue hemorrhagic fever cases (solid line) over the course of the illness. Fever day 0 denotes day of defervescence. * different from dengue fever cases (P < .05). The numbers of cases were: fever-day -3 (DF 4, DHF 5), fever-day-2 (DF 13, DHF 9), fever-day-1(DF 43, DHF 26), fever-day-0(DF 104, DHF 56), fever-day+1(DF 119, DHF 62), fever-day+2(DF 70, DHF 60), fever-day+3(DF 13, DHF 38).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4520477&req=5

pntd.0003943.g001: Hemodynamic status and plasma leakage in dengue by fever day.Heart rate (A), systolic blood pressure (B), diastolic blood pressure (C), inferior vena cava diameter (D), mean cardiac index (E), systemic vascular resistance (F), frequencies of cases with a pleural effusion or ascites (G), and daily fluid intake (H) of dengue fever (dotted line) and dengue hemorrhagic fever cases (solid line) over the course of the illness. Fever day 0 denotes day of defervescence. * different from dengue fever cases (P < .05). The numbers of cases were: fever-day -3 (DF 4, DHF 5), fever-day-2 (DF 13, DHF 9), fever-day-1(DF 43, DHF 26), fever-day-0(DF 104, DHF 56), fever-day+1(DF 119, DHF 62), fever-day+2(DF 70, DHF 60), fever-day+3(DF 13, DHF 38).
Mentions: Fig 1 shows the patterns of hemodynamic and volume indices and fluid intake over the course of the illness of DF and DHF cases. DHF cases had higher heart rate compared to DF early in the course of illness and this persisted throughout the acute illness (A). There was no difference in systolic blood pressure (B), but mean diastolic pressures were higher in DHF cases around the day of fever resolution (fever day 0) and shortly thereafter (C). This coincided with decreased intravascular volume as indicated by a decrease in the average IVC diameter in DHF cases (D). DHF cases had lower CI (E) at defervescence (fever day 0) and increased SVR (F) on fever day 0 and +1 compared to DF cases. Ultrasonography revealed a gradual increase in the percentage of cases with plasma leakage, with peak incidence on fever day +1 (G). Patients with DHF also received more fluid compared to those with DF starting on fever day 0 and afterward.

Bottom Line: Cardiac dysfunction was transient and did not require treatment.Transient elevated troponin-T levels were more common in DHF cases compared to DF (14.5% vs 5%, p = 0.028).Cardiac structural changes including myocarditis were uncommon.

View Article: PubMed Central - PubMed

Affiliation: Queen Sirikit National Institute of Child Health, Bangkok, Thailand.

ABSTRACT

Background: Infection with dengue virus results in a wide range of clinical manifestations from dengue fever (DF), a self-limited febrile illness, to dengue hemorrhagic fever (DHF) which is characterized by plasma leakage and bleeding tendency. Although cardiac involvement has been reported in dengue, the incidence and the extent of cardiac involvement are not well defined.

Methods and principal findings: We characterized the incidence and changes in cardiac function in a prospective in-patient cohort of suspected dengue cases by serial echocardiography. Plasma leakage was detected by serial chest and abdominal ultrasonography. Daily cardiac troponin-T levels were measured. One hundred and eighty one dengue cases were enrolled. On the day of enrollment, dengue cases that already developed plasma leakage had lower cardiac index (2695 (127) vs 3188 (75) (L/min/m2), p = .003) and higher left ventricular myocardial performance index (.413 (.021) vs .328 (.026), p = .021) and systemic vascular resistance (2478 (184) vs 1820 (133) (dynes·s/cm5), p = .005) compared to those without plasma leakage. Early diastolic wall motion of the left ventricle was decreased in dengue cases with plasma leakage compared to those without. Decreased left ventricular wall motility was more common in dengue patients compared to non-dengue cases particularly in cases with plasma leakage. Differences in cardiac function between DF and DHF were most pronounced around the time of plasma leakage. Cardiac dysfunction was transient and did not require treatment. Transient elevated troponin-T levels were more common in DHF cases compared to DF (14.5% vs 5%, p = 0.028).

Conclusions: Transient left ventricular systolic and diastolic dysfunction was common in children hospitalized with dengue and related to severity of plasma leakage. The functional abnormality spontaneously resolved without specific treatment. Cardiac structural changes including myocarditis were uncommon.

No MeSH data available.


Related in: MedlinePlus