24-hour Holter findings in infants with in-utero exposure to the Zika virus: a series of cases

Orofino, Dulce Helena Gonçalves; Passos, Sônia Regina Lambert; Pone, Sheila Moura; Pone, Marcos Vinícius da Silva; Aguiar, Elisa Barroso de; Araújo, Igo Oliveira de; Ramos, Thiago Moreira; Silva, Leticia Machado Lima e; Oliveira, Bruna Menezes de; Silva, Luan Noé da; Goldenzon, Rafaela Valentim; Moreira, Maria Elizabeth Lopes; Oliveira, Raquel

doi:10.1590/s1678-9946202062050

Cited by 5 publications

(7 citation statements)

References 23 publications

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“…After applying the inclusion and the exclusion criteria, we included 42 studies, distributed as follows: 34 articles on dengue [31,; 6 studies on chikungunya [32,[74][75][76][77][78]; and 2 on Zika [79,80]. Two studies used a control group of people exposed to arboviruses [32,47].…”

Section: Resultsmentioning

confidence: 99%

Heart Disease and Arboviruses: A Systematic Review and Meta-Analysis

Nicacio

Gomes

Carmo

et al. 2022

Viruses

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Dengue fever, chikungunya, and zika are highly prevalent arboviruses transmitted by hematophagous arthropods, with a widely neglected impact in developing countries. These diseases cause acute illness in diverse populations, as well as potential cardiovascular complications. A systematic review was carried out to investigate the burden of cardiac involvement related to these arboviruses. Multiple databases were searched for articles that investigated the association of cardiovascular diseases with arboviruses, published up to March 2022. Relevant articles were selected and rated by two independent reviewers. Proportion meta-analysis was applied to assess the frequency-weighted mean of the cardiovascular findings. A total of 42 articles were selected (n = 76,678 individuals), with 17 manuscripts on dengue and 6 manuscripts on chikungunya undergoing meta-analysis. The global pooled incidence of cardiac events in dengue fever using a meta-analysis was 27.21% (95% CI 20.21–34.83; I2 = 94%). The higher incidence of dengue-related myocarditis was found in the population younger than 20 years old (33.85%; 95% CI 0.00–89.20; I2 = 99%). Considering the studies on chikungunya (n = 372), the global pooled incidence of cardiac involvement using a meta-analysis was 32.81% (95% CI 09.58–61.49, I2 = 96%). Two Zika studies were included that examined cases of infection by vertical transmission in Brazil, finding everything from structural changes to changes in heart rate variability that increase the risk of sudden death. In conclusion, cardiac involvement in arboviruses is not uncommon, especially in dengue fever.

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Section: Resultsmentioning

confidence: 99%

Heart Disease and Arboviruses: A Systematic Review and Meta-Analysis

Nicacio

Gomes

Carmo

et al. 2022

Viruses

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“…Furthermore, another descriptive study analyzed a sample of 15 newborns by cardiac Holter and found no records of alterations such as supraventricular or ventricular extrasystoles, QT interval blocks or changes, conduction pauses, or junctional rhythm. Nonetheless, a significant difference in the standard deviation values of 18 .…”

Section: Discussionmentioning

confidence: 96%

Cardiovascular disorders in patients with Zika Virus: integrative review

Rezende¹,

Freitas²,

Catabriga³

et al. 2022

Rev Cienc Saude

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Objective: To describe the primary cardiovascular disorders manifested in patients infected with the zika virus and understand the pathophysiological process. Methods: This integrative literature review occurred in January 2021 through the PICO strategy, which answered the guiding question: “What are the main cardiovascular disorders manifested in patients infected with zika virus?” For this, a time interval of 5 years was defined, using the descriptors “Zika Virus”,“Heart” and “Cardiovascular Diseases” in English, Portuguese and Spanish. The contemplated databases were MEDLINE, LILACS, and BDENF. Results: There were a total of 77,872 articles, of which, after the exclusion and inclusion processes, it was summarized in eight articles included in this review. The main cardiovascular findings present were apical muscular ventricular septal defect and ostium secundum, in addition to atrial fibrillation and heart failure with reduced ejection fraction. Conclusions: Further studies with more robustness that clearly establish the mechanism of cellular tropism for cardiac muscle cells and involve the pathophysiological process of cardiac alterations more clearly and reliably are needed.

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Section: Discussionmentioning

confidence: 99%

“…In contrast to Orofino et al (2020) where 18-24 h of ECG was used to compute HRV, here we identify ZIKV exposure using HRV derived from ECG recordings of only 20 min duration. Unlike in the present study, SDNN was reduced in infants with severe microcephaly or in infants with CZS compared to healthy controls (Orofino et al 2020). We did not find differences in the highly correlated SDNN equivalent, Poincaré SD2 metric of HRV, in the asymptomatic infants exposed to ZIKV in utero compared to controls (Brennan et al 2001a).…”

Section: Discussionmentioning

confidence: 99%

“…Following our early preprint publication of this work, (Herry et al 2018) a report in a cohort of 15 infants with vertical exposure to ZIKV was published (Orofino et al 2020). Using conventional group statistical comparisons and 24h Holter recordings with at least 18 h of clean ECG, the authors showed that SDNN, a linear domain statistical measure of HRV, is reduced in infants with severe microcephaly or in infants with CZS.…”

Section: Introductionmentioning

confidence: 99%

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Machine learning model on heart rate variability metrics identifies asymptomatic toddlers exposed to zika virus during pregnancy

et al. 2021

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Objective. Although the Zika virus (ZIKV) seems to be prominently neurotropic, there are some reports of involvement of other organs, particularly the heart. Of special concern are those children exposed prenatally to ZIKV and born without microcephaly or other congenital anomalies. Electrocardiogram (ECG)—derived heart rate variability (HRV) metrics represent an attractive, low-cost, widely deployable tool for early identification of developmental functional alterations in exposed children born without such overt clinical symptoms. We hypothesized that HRV in such children would yield a biomarker of fetal ZIKV exposure. Our objective was to test this hypothesis in young children exposed to ZIKV during pregnancy. Approach. We investigated the HRV properties of 21 children aged 4–25 months from Brazil. The infants were divided into two groups, the ZIKV-exposed (n = 13) and controls (n = 8). Single-channel ECG was recorded in each child at ∼15 months of age and HRV was analyzed in 5 min segments to provide a comprehensive characterization of the degree of variability and complexity of the heart rate. Main results. Using a cubic support vector machine classifier we identified babies as Zika cases or controls with a negative predictive value of 92% and a positive predictive value of 86%. Our results show that a machine learning model derived from HRV metrics can help differentiate between ZIKV-affected, yet asymptomatic, and non-ZIKV-exposed babies. We identified the box count as the best HRV metric in this study allowing such differentiation, regardless of the presence of microcephaly. Significance. We show that it is feasible to measure HRV in infants and toddlers using a small non-invasive portable ECG device and that such an approach may uncover the memory of in utero exposure to ZIKV. We discuss putative mechanisms. This approach may be useful for future studies and low-cost screening tools involving this challenging to examine population.

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24-hour Holter findings in infants with in-utero exposure to the Zika virus: a series of cases

Abstract: This is an open-access article distributed under the terms of the Creative Commons Attribution License.

Cited by 5 publications

References 23 publications

Heart Disease and Arboviruses: A Systematic Review and Meta-Analysis

Heart Disease and Arboviruses: A Systematic Review and Meta-Analysis

Cardiovascular disorders in patients with Zika Virus: integrative review

Machine learning model on heart rate variability metrics identifies asymptomatic toddlers exposed to zika virus during pregnancy

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