Evaluation of Cardiac Involvement in Children with Dengue by Serial Echocardiographic Studies
Authors
Kirawittaya, TawatchaiYoon, In-Kyu
Wichit, Sineewanlaya
Green, Sharone
Ennis, Francis A.
Gibbons, Robert V.
Thomas, Stephen J.
Rothman, Alan L.
Kalayanarooj, Siripen
Srikiatkhachorn, Anon
UMass Chan Affiliations
Division of Infectious Diseases and Immunology, Department of MedicineDocument Type
Journal ArticlePublication Date
2015-07-30Keywords
Dengue feverBlood plasma
Fevers
Hemodynamics
Myocarditis
Ultrasound imaging
Convalescence
Echocardiography
Cardiovascular System
Immunology and Infectious Disease
Virus Diseases
Metadata
Show full item recordAbstract
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.Source
PLoS Negl Trop Dis. 2015 Jul 30;9(7):e0003943. doi: 10.1371/journal.pntd.0003943. eCollection 2015. Link to article on publisher's siteDOI
10.1371/journal.pntd.0003943Permanent Link to this Item
http://hdl.handle.net/20.500.14038/39746PubMed ID
26226658Related Resources
Link to Article in PubMedRights
This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
Distribution License
http://creativecommons.org/publicdomain/zero/1.0/ae974a485f413a2113503eed53cd6c53
10.1371/journal.pntd.0003943
Scopus Count
Collections
Except where otherwise noted, this item's license is described as <p>This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the <a href="https://creativecommons.org/publicdomain/zero/1.0/">Creative Commons CC0</a> public domain dedication.</p>