Transient depression of myocardial function after influenza virus infection: A study of echocardiographic tissue imaging

Abstract

Background Influenza virus infection (IVI) was reported to be associated with minor cardiac changes, mostly those detected on electrocardiogram with and without elevated blood markers of myocardial injury; however, the characteristics of myocardial involvement in association with IVI are poorly understood. This study used echocardiographic tissue imaging (tissue Doppler, strain, and strain rate) to evaluate changes in left atrial (LA) and left ventricular (LV) myocardial function after IVI. Methods and results We examined 20 adult individuals (mean age, 43 years) at 2 and 4 weeks after diagnosis of IVI. For myocardial functional variables, we obtained LV global longitudinal strain (GLS), LV early diastolic strain rate (e'sr), LA strain, and LA stiffness (E/e’/LA strain), in addition to data on tissue Doppler (s’, e’, and a’) and myocardial performance index. Blood markers of myocardial injury were also examined. During follow-up, there were no significant changes in global chamber function such as LV ejection fraction, E/e’, and LA volume. However, significant changes in myocardial function were observed, namely, in s’ (8.0 ± 1.6 cm/s to 9.3 ± 1.5 cm/s; p = 0.01), e’ (10.2 ± 2.8 cm/s to 11.4 ± 3.0 cm/s; p < 0.001), e’sr (1.43 ± 0.44 1/s to 1.59 ± 0.43 1/s; p = 0.005), and LA strain (35 ± 8% to 40 ± 12%; p = 0.025), and the myocardial performance index (0.52 ± 0.20 to 0.38 ± 0.09; p = 0.009), but not in a’, LA stiffness, or GLS. Cardiac troponin T and creatinine kinase isoenzyme MB were not elevated significantly at any examination. Conclusions Myocardial dysfunction during IVI recovery appeared to be transient particularly in the absence of myocardial injury. Echocardiographic tissue imaging may be useful to detect subclinical cardiac changes in association with IVI.

Recommendations for the prevention, diagnosis and treatment of inFLUenza in adults for Primary care physiciAnS: FLU COMPAS PCP – ADULTS

“…More recent studies indicate that the transient depression of myocardial function in patients with influenza infection detected by echocardiographic tissue imaging may occur more frequently than previously thought, and may not necessarily increase the risk of myocarditis. this study by ito et al [19] concerned, however, a small population of patients without elevated blood markers of myocardial injury.…”

Falsely Elevated Troponin I Levels in Influenza H1N1 Positive Patient

“…In the present case high sensitivity Trop, I test was used which allow accurate detection of Trop I levels whereas literature studies have been done on other contemporary assays with heterogeneous cut offs. [18][19][20] The elevated Trop I levels in H1N1 infection are indicator of poor prognosis but the timely testing for H1N1 in current case helped clinician to start antiviral Tamiflu immediately and such prompt intervention resulted in favorable uneventful recovery of patient.…”

Cardiac troponin elevation in patients with influenza virus infections

“…First, a limited number of studies have used the novel HS immunoassays, which allow much more accurate detection of a vast array of cardiac injuries, both ischemic and non-ischemic [ 25 ]. Specifically, only a total of three studies (total n = 323) used HS assays [ 15 , 20 , 22 ], while the rest of the studies used contemporary sensitive or unspecified immunoassays. Likewise, the cut-offs used in the various investigations are rather heterogeneous, some coincide with the URL, others are considerably higher than the conventional diagnostic thresholds.…”

“…2013 [ 15 ] 39 patients with Influenza A H1N1 virus infection (mean age, 48 ± 17 years; 52% women) HS-cTnI (unspecified cut-off) rRT-PCR cTn values increase in parallel with the severity of cardiac dysfunction Han et al., 2015 [ 16 ] 40 patients with Influenza A H7N9 infection (60 ± 15 years; 45 women) Unspecified cTnI assay (<13 ng/L) rRT-PCR cTn values higher during infection and also higher in patients with more severe form of disease Ludwig et al., 2015 [ 17 ] 600 patients with laboratory-confirmed influenza (no demographic data available) Different facilities used different tests with varying reference ranges Different facilities used different tests cTn values exceeding the local cutoff in 24% of patients Wang et al., 2017 [ 18 ] 24 patients with Influenza A H7N9 (mean age, 59 ± 18 years; 29% women) and 22 patients with Influenza A pH1N1 (mean age, 42 ± 16 years; 62% women) infections Unspecified cTnI assay (unspecified cut-off) rRT-PCR cTn values increased in 33% H7N9 patients and in 5.0% H1N1 patients Qian et al., 2017 [ 19 ] 15 patients with severe Influenza A H1N1 infection (47% women; mean age was 53 ± 13 and 61 ± 15 years in those who survived or died) Unspecified rRT-PCR cTn values 3.5-fold higher in patients who died compared to those who survived Ito et al. 2019 [ 20 ] 20 patients with Influenza virus infection (15 with type A and 5 with type B; mean age, 43 ± 13 years; 75% women) HS-cTnT (<14 ng/L) Immunochromatography No patient displayed elevation of either cTnT above the URL Harris et al., 2019 [ 21 ] 1131 patients with Influenza virus infection (mean age, 71 ± 12 years; 61% women) Unspecified cTnI assay (<300 ng/L) rRT-PCR cTn values exceeding the diagnostic cut-off in 1.1–3.5% of patients Pizzini et al. 2020 [ 22 ] 264 patients with laboratory-confirmed Influenza virus infection (mean age, 51 ± 22 years; 50% women) HS-cTnT (<14 ng/L) rRT-PCR cTn values 9-fold higher in patients who died compared to those who survived Abbreviations: cTnI: cardiac troponin I; cTnT: cardiac troponin T; CS:...…”

“…Ito et al. [ 20 ] studied 20 adult patients diagnosed with Influenza virus infection. The value of cTnT measured with a HS immunoassay 2 and 4 weeks after the diagnosis of Influenza infection was found to be lower than the URL in all patients.…”