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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

Plasma troponin-T levels in individual DF (white circles) or DHF cases (black circles) during the course of the illness.The horizontal line indicates a cut-off for an abnormal value at 30 pg/ml.
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pntd.0003943.g005: Plasma troponin-T levels in individual DF (white circles) or DHF cases (black circles) during the course of the illness.The horizontal line indicates a cut-off for an abnormal value at 30 pg/ml.

Mentions: Troponin and CPK-MB levels were similar between dengue and non-dengue cases on the day of study enrollment. Plasma levels of cardiac troponin-T were low to non-detectable in most cases with comparable levels found in DF and DHF cases throughout the acute illness period. Consistent with this finding, the mean levels of CPK-MB were similar between DF and DHF. However, 14.5% of DHF cases had troponin-T levels >30 ng/L at any time point compared to 5% in DF (p = 0.028, Chi-square test). All of these cases had only one sample with elevated troponin-T levels during the course of illness. These elevated troponin levels were detected later in the course of the illness (Fig 5). There were no cases with clinical heart failure or conductive defects consistent with clinical myocarditis.


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)

Plasma troponin-T levels in individual DF (white circles) or DHF cases (black circles) during the course of the illness.The horizontal line indicates a cut-off for an abnormal value at 30 pg/ml.
© Copyright Policy
Related In: Results  -  Collection

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

pntd.0003943.g005: Plasma troponin-T levels in individual DF (white circles) or DHF cases (black circles) during the course of the illness.The horizontal line indicates a cut-off for an abnormal value at 30 pg/ml.
Mentions: Troponin and CPK-MB levels were similar between dengue and non-dengue cases on the day of study enrollment. Plasma levels of cardiac troponin-T were low to non-detectable in most cases with comparable levels found in DF and DHF cases throughout the acute illness period. Consistent with this finding, the mean levels of CPK-MB were similar between DF and DHF. However, 14.5% of DHF cases had troponin-T levels >30 ng/L at any time point compared to 5% in DF (p = 0.028, Chi-square test). All of these cases had only one sample with elevated troponin-T levels during the course of illness. These elevated troponin levels were detected later in the course of the illness (Fig 5). There were no cases with clinical heart failure or conductive defects consistent with clinical myocarditis.

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