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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

Tissue Doppler image of LV functions by fever day.Left ventricular lateral (A) and septal S wave (B), LV mean performance index (MPI) (C), lateral (D) and septal (E) annulus movement during early diastole, lateral (F) and septal (G) annulus movement during late diastole, and lateral (H) and medial (I) E/Ea ratios of dengue fever (dotted line) and dengue hemorrhagic fever (solid line) cases over the course of the illness. Fever day 0 denotes day of defervescence. * different from DF (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.g003: Tissue Doppler image of LV functions by fever day.Left ventricular lateral (A) and septal S wave (B), LV mean performance index (MPI) (C), lateral (D) and septal (E) annulus movement during early diastole, lateral (F) and septal (G) annulus movement during late diastole, and lateral (H) and medial (I) E/Ea ratios of dengue fever (dotted line) and dengue hemorrhagic fever (solid line) cases over the course of the illness. Fever day 0 denotes day of defervescence. * different from DF (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: TDI of the MV showed slower septal movement during systole in DHF compared to DF on fever day +1 (p = .031) (Fig 3B). Early and late diastolic LV annulus motions (Ea and Aa wave) were lower in DHF cases compared to DF cases at the end of the febrile period and after (Fig 3D, 3E and 3F). The decreased early diastolic annulus motion was more pronounced in the septal area. The E/Ea ratio, which indicates LV filling pressure, was not different between DHF and DF cases on most days except on fever day +1 when the average E/Ea ratio was significantly lower in DHF cases (I).


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)

Tissue Doppler image of LV functions by fever day.Left ventricular lateral (A) and septal S wave (B), LV mean performance index (MPI) (C), lateral (D) and septal (E) annulus movement during early diastole, lateral (F) and septal (G) annulus movement during late diastole, and lateral (H) and medial (I) E/Ea ratios of dengue fever (dotted line) and dengue hemorrhagic fever (solid line) cases over the course of the illness. Fever day 0 denotes day of defervescence. * different from DF (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

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

pntd.0003943.g003: Tissue Doppler image of LV functions by fever day.Left ventricular lateral (A) and septal S wave (B), LV mean performance index (MPI) (C), lateral (D) and septal (E) annulus movement during early diastole, lateral (F) and septal (G) annulus movement during late diastole, and lateral (H) and medial (I) E/Ea ratios of dengue fever (dotted line) and dengue hemorrhagic fever (solid line) cases over the course of the illness. Fever day 0 denotes day of defervescence. * different from DF (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: TDI of the MV showed slower septal movement during systole in DHF compared to DF on fever day +1 (p = .031) (Fig 3B). Early and late diastolic LV annulus motions (Ea and Aa wave) were lower in DHF cases compared to DF cases at the end of the febrile period and after (Fig 3D, 3E and 3F). The decreased early diastolic annulus motion was more pronounced in the septal area. The E/Ea ratio, which indicates LV filling pressure, was not different between DHF and DF cases on most days except on fever day +1 when the average E/Ea ratio was significantly lower in DHF cases (I).

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