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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

Left ventricular functions in dengue by fever day.Ejection fraction (A), early diastolic LV inflow flow (B), and late diastolic LV inflow (C) 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 (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.g002: Left ventricular functions in dengue by fever day.Ejection fraction (A), early diastolic LV inflow flow (B), and late diastolic LV inflow (C) 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 (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: Evaluation of LV systolic and diastolic functions revealed lower EFs (Fig 2A) on fever day -1 and 0, and lower early component of LV inflow (MV-E wave) on fever days 0 and +1 (Fig 2B) in DHF compared to DF. The late component LV inflow was also decreased in DHF on fever day +1 (Fig 2C). Seventeen dengue cases had at least one abnormal EF (<56%) detected during the illness. They represented 7%, 9%, 15%, and 32% of DF, DHF grade I, II, and DHF Gr III/IV cases, respectively. The relative frequencies of abnormal EFs were higher in DHF grade III/IV compared to DHF grade I/II and DF (p < .001, Chi-square). The majority of cases (67%) had low EF detected on only a single day, usually fever day 0 or +1. The EFs on the day of discharge were improved compared to the lowest EF. Taken together, this indicates that changes in hemodynamic status in DHF were temporally associated with plasma leakage and were characterized by a compensatory autonomic response to contracted intravascular volume which was corrected by fluid replacement.


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)

Left ventricular functions in dengue by fever day.Ejection fraction (A), early diastolic LV inflow flow (B), and late diastolic LV inflow (C) 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 (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.g002: Left ventricular functions in dengue by fever day.Ejection fraction (A), early diastolic LV inflow flow (B), and late diastolic LV inflow (C) 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 (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: Evaluation of LV systolic and diastolic functions revealed lower EFs (Fig 2A) on fever day -1 and 0, and lower early component of LV inflow (MV-E wave) on fever days 0 and +1 (Fig 2B) in DHF compared to DF. The late component LV inflow was also decreased in DHF on fever day +1 (Fig 2C). Seventeen dengue cases had at least one abnormal EF (<56%) detected during the illness. They represented 7%, 9%, 15%, and 32% of DF, DHF grade I, II, and DHF Gr III/IV cases, respectively. The relative frequencies of abnormal EFs were higher in DHF grade III/IV compared to DHF grade I/II and DF (p < .001, Chi-square). The majority of cases (67%) had low EF detected on only a single day, usually fever day 0 or +1. The EFs on the day of discharge were improved compared to the lowest EF. Taken together, this indicates that changes in hemodynamic status in DHF were temporally associated with plasma leakage and were characterized by a compensatory autonomic response to contracted intravascular volume which was corrected by fluid replacement.

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