Spectrum of cardiac involvement in patients with dengue fever. (1st February 2021)

• Record Type: Journal Article
• Authors: Shah, Chintan; Vijayaraghavan, Govindan; Kartha, Chandrasekharan C.
• Is Part Of: International journal of cardiology. Volume 324(2021)
• Page Start: 180
• Page End: 185
• Publication Date: 2021-02-01
• Subjects: Dengue fever -- Cardiac involvement -- Cardiac arrhythmias -- Left ventricular dysfunction -- Cardiac failure -- Cardiac biomarkers; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2020.09.034
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Dengue fever (DF) is an infectious disease of viral origin common in the tropics. Studies on a large number of patients with dengue infection to assess associated cardiac involvement are rare. Methods: We analyzed the incidence and spectrum of cardiac abnormalities in 320 patients with dengue fever admitted to our hospital located in an endemic area for dengue infection. All patients were evaluated following the WHO guidelines. Those confirmed to have dengue infection by serology had detailed clinical evaluation, 12‑lead electrocardiography (ECG), assay for cardiac markers (troponin T, CK-MB, NT Pro BNP) and 2-D echocardiography. Results: Among the 320 patients selected for the study 112 (35%) had changes of cardiac involvement as detected by investigations. Changes in ECG were seen in all of them. Sinus bradycardia in spite of fever was the most common abnormality ( n = 63;19.7%). Forty-two (13.1%) patients had left ventricular ejection fraction less than 40%. Forty-eight patients (15%) had increased serum levels of troponin-T. Serum levels of CK-MB were elevated in 34 (10.6%) and serum levels of NT-pro BNP was increased in 19 (5.9%). Fourteen patients died and all of them had abnormalities in electrocardiogram, echocardiogram and serum markers. Conclusion: Our study reveals that cardiac involvement in patients with dengue infection is not uncommon. We found that ECHO or ECG abnormalities or elevated serum levels of markers of cardiac injury are predictors of risk for adverse outcome. Absence of these abnormalities has a 100% negative predictive value. Highlights: Cardiac involvement is not rare in patients with dengue fever. Most common cardiac dysfunction is sinus bradycardia. Rising serum levels of markers of cardiac injury is indicative of bad prognosis. Patients with left ventricular dysfunction should be looked for by echocardiography. Abnormalities in either ECHO or ECG or elevated serum levels of markers of cardiac injury are predictors of risk for adverse outcome. Lack of ECG and ECHO abnormalities and normal serum levels of markers of cardiac injury has a 100% negative predictive value.