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

Abstract

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.

Seroprevalence and biochemical parameters among patients with Chikungunya in Adamaoua region, Cameroon: A cross‐sectional study

“…This finding, along with previous reports, suggests that although the presence of the virus increases the risk of liver damage, injury to other target organs such as the heart and muscles is greater [33]. CHIKV has a strong proclivity to infect tissues, such as the spleen, bones, heart, lungs, and skin [35], leading to organ dysfunction and blood AST elevations. In some studies, the high AST levels were positively correlated with high prevalences of arthralgia in children [11].…”

Skin muscle is the initial site of viral replication for arboviral bunyavirus infection

“…Indeed, Chikungunya, Dengue, and Zika have all been reported to infect skeletal muscle across animal models and human samples 13,26,[28][29][30][31] . Approximately 25% of clinical human DENV and CHIKV patients have myocardial involvement, indicating that arboviral infections can readily occur in the heart 32 . We detected high levels of LACV transcripts in large muscle tissues in our mouse model including the thigh muscle and heart in later stages of infection.…”

Complicações cardíacas associadas a infecção por Chikungunya: uma revisão de literatura

“…Além disso, esses arbovírus (principalmente dengue e chikungunya) vêm atingindo outras áreas ecológicas, como países de clima temperado, através da expansão descontrolada de outro importante vetor -Aedes albopictus, gerando grandes surtos e um ciclo sustentado de doenças, com graves problemas de saúde e repercussões. 5 Em relação a Chikungunya, o comprometimento cardíaco não é frequente em episódios isolados. Entretanto, nos países onde o vírus tem um potencial epidêmico elevado, deve-se ficar atento com essa condição, especialmente quando ocorrem surtos e/ou na presença de outras arboviroses, como a Dengue e a Zika.…”

“…Entretanto, nos países onde o vírus tem um potencial epidêmico elevado, deve-se ficar atento com essa condição, especialmente quando ocorrem surtos e/ou na presença de outras arboviroses, como a Dengue e a Zika. [3][4][5] A miocardite é a apresentação cardiovascular mais frequente da doença, e é fundamental considerá-la precocemente por dois motivos principais: primeiro, devido às complicações que podem desenvolver-se na fase aguda ou subaguda da doença. O envolvimento cardíaco é a principal causa de morte nestes pacientes.…”