Myocardial depression in dengue hemorrhagic fever: Prevalence and clinical description*

Khongphatthanayothin, Apichai; Lertsapcharoen, Pornthep; Supachokchaiwattana, Pentip; La-orkhun, Vidhawas; Khumtonvong, Aree; Boonlarptaveechoke, Charoon; Pancharoen, Chitsanu

doi:10.1097/01.pcc.0000288672.77782.d4

Cited by 52 publications

(49 citation statements)

References 19 publications

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“…Myocardial dysfunction was associated with respiratory distress but not with recurrent shock, suggesting the myocardial impairment was sufficient to play a role in fluid overload, following resuscitation and the associated respiratory compromise but not to contribute to the shock syndrome, which appears to be driven predominantly by intravascular volume depletion. These findings are comparable to other echo studies, including one study of Thai children which demonstrated 36% of patients with DSS had reduced systolic function and patients with cardiac impairment were more likely to have fluid overload [18]. The mechanisms underlying this transient myocardial dysfunction in dengue patients remain to be defined, but potential mechanisms may involve some or a combination of the following; myocardial depressant factors, myocardial interstitial oedema, abnormal coronary microcirculation and endothelial dysfunction and also abnormal calcium homeostasis [8, 19, 20].…”

Section: Discussionsupporting

confidence: 87%

Cardio-haemodynamic assessment and venous lactate in severe dengue: Relationship with recurrent shock and respiratory distress

et al. 2017

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BackgroundDengue can cause plasma leakage that may lead to dengue shock syndrome (DSS). In approximately 30% of DSS cases, recurrent episodes of shock occur. These patients have a higher risk of fluid overload, respiratory distress and poor outcomes. We investigated the association of echocardiographically-derived cardiac function and intravascular volume parameters plus lactate levels, with the outcomes of recurrent shock and respiratory distress in severe dengue.Methods/Principle findingsWe performed a prospective observational study in Paediatric and adult ICU, at the Hospital for Tropical Diseases (HTD), Ho Chi Minh City, Vietnam. Patients with dengue were enrolled within 12 hours of admission to paediatric or adult ICU. A haemodynamic assessment and portable echocardiograms were carried out daily for 5 days from enrolment and all interventions recorded.102 patients were enrolled; 22 patients did not develop DSS, 48 had a single episode of shock and 32 had recurrent shock. Patients with recurrent shock had a higher enrolment pulse than those with 1 episode or no shock (median: 114 vs. 100 vs. 100 b/min, P = 0.002), significantly lower Stroke Volume Index (SVI), (median: 21.6 vs. 22.8 vs. 26.8mls/m2, P<0.001) and higher lactate levels (4.2 vs. 2.9 vs. 2.2 mmol/l, P = 0.001). Higher SVI and worse left ventricular function (higher Left Myocardial Performance Index) on study days 3–5 was associated with the secondary endpoint of respiratory distress. There was an association between the total IV fluid administered during the ICU admission and respiratory distress (OR: 1.03, 95% CI 1.01–1.06, P = 0.001). Admission lactate levels predicted patients who subsequently developed recurrent shock (P = 0.004), and correlated positively with the total IV fluid volume received (rho: 0.323, P = 0.001) and also with admission ALT (rho: 0.764, P<0.001) and AST (rho: 0.773, P<0.001).Conclusions/SignificanceEcho-derived intravascular volume assessment and venous lactate levels can help identify dengue patients at high risk of recurrent shock and respiratory distress in ICU. These findings may serve to, not only assist in the management of DSS patients, but also these haemodynamic endpoints could be used in future dengue fluid intervention trials.

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Section: Discussionsupporting

confidence: 87%

Cardio-haemodynamic assessment and venous lactate in severe dengue: Relationship with recurrent shock and respiratory distress

et al. 2017

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“…A series of 91 children with dengue hemorrhagic fever or dengue shock syndrome found no patients with troponin T elevation, despite demonstrating that 36% of victims had significant acute reductions in LVEF over the course of the illness (180). Troponin T levels were not statistically different between Plasmodium falciparum-infected patients with uncomplicated malaria and those with clinical cardiac involvement (181).…”

Section: Infection and Myocarditismentioning

confidence: 97%

ACCF 2012 Expert Consensus Document on Practical Clinical Considerations in the Interpretation of Troponin Elevations

Newby

Jesse²,

Babb³

et al. 2012

Journal of the American College of Cardiology

346

134

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“…It has been demonstrated that patients with DSS are more prone to myocardial depression with reduction of the left and/or right ventricular function. One study performed in Thailand involving 99 paediatric patients revealed that approximately onethird (9/25) of DSS patients had a ventricular ejection fraction less than 50 % at the critical stage [23]. On the other hand, myocarditis can be completely asymptomatic, as shown by a study conducted in Sri Lanka, revealing 24 % (44/85) of dengue patients with echocardiographic evidence of myocarditis, without any cardiac complaints and with complete resolution during convalescence [3].…”

Section: Casementioning

confidence: 99%

Dengue myocarditis in Singapore: two case reports

2013

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The authors report two cases of complicated dengue viral infection with acute myocarditis involving young male adults, of which one was fatal. The first case presented with typical signs of myocardial disease: chest pain and diaphoresis with myocardial depression in the electrocardiograph. The second case deteriorated rapidly and demised within the first day of admission. Histology of the heart muscles showed multiple small foci of myocyte necrosis surrounded by lymphocytes, in keeping with viral myocarditis. Both cases fulfilled the World Health Organization (WHO) diagnosis of probable dengue: the first case had positive dengue serology, both IgM and IgG at day six of illness, and the second case was polymerase chain reaction (PCR) positive for dengue and identified as serotype 2. Despite the severe outcome, both cases did not completely fulfil the criteria for dengue haemorrhagic fever (DHF). Although severe cardiac impairment is not commonly reported in dengue infection, it can be life threatening.

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Myocardial depression in dengue hemorrhagic fever: Prevalence and clinical description*

Abstract: Transient myocardial depression is not uncommon in patients with DSS. Cardiac dysfunction in children with DSS may contribute to the clinical severity and the degree of fluid overload in these patients.

Cited by 52 publications

References 19 publications

Cardio-haemodynamic assessment and venous lactate in severe dengue: Relationship with recurrent shock and respiratory distress

Cardio-haemodynamic assessment and venous lactate in severe dengue: Relationship with recurrent shock and respiratory distress

ACCF 2012 Expert Consensus Document on Practical Clinical Considerations in the Interpretation of Troponin Elevations

Dengue myocarditis in Singapore: two case reports

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