Dengue hemorrhagic fever and cardiac involvement

Table 2 Incidence and clinical manifestations of dengue viral infections with cardiac involvement

Ref.	Diagnosis	Study population	Incidence, %	Cardiac assessment methods	Main findings and clinical outcomes
Wali et al[24], 1998	DHF/DSS	17 (14-58 yr)	70.59	ECG. ECHO. Radionuclide ventriculography. Tc-99m pyrophosphate imaging	ECG showed ST and T wave changes (29.4%). Mean LVEF = 41.7%. Mean LVEF in DSS patients = 39.63%
Kabra et al[25], 1998	DF/DHF/DSS	54 (< 12 yr)	16.70	ECHO	LVEF < 50% in 16.7% of patients. LVEF < 35% in 3.7% of patients. Repeat ECHO after 2 mo showed improved LVEF
Khongphatthanayothin et al[26], 2003	DHF	24 (10.8 ± 2.8 yr)	-	ECHO (VCFC/ESS)	Lower LVEF, VCFC/ESS, CI, EDV and higher SVR during critical phase vs recovery phase
Kularatne et al[27], 2007	DF	120 (13-76 yr)	62.50	ECG. Cardiac markers	ECG abnormalities: (1) Sinus bradycardia; (2) ST-segment changes; (3) T wave changes; and (4) Right bundle branch block in 62.5% of patients; increased troponin levels in 29.4% of 17 patients
Khongphatthanayothin et al[28], 2007	DF/DHF/DSS	91 (5-15 yr)	17.58	ECHO. Cardiac markers	Reduced LVEF (< 50%) was found in 6.7%, 13.8%, and 36% of patients with DF, DHF, and DSS during the critical phase, respectively. No abnormal cardiac markers
Salgado et al[29], 2009	DF/DHF	102 (13 mo-10 yr)	10.70	ECG. ECHO	ECG: (1) Sinus bradycardia in 81.8% of 11 patients; and (2) Tachycardia in 18.2% of 11 patients, and T wave inversion in seven of 11 patients. ECHO: Pericardial effusions in 71.4% of 7 patients
La-Orkhun et al[30], 2011	DF/DHF/DSS	35 (5-15 yr)	29.00	ECG, 24-h Holter monitoring	During recovery phase: (1) Sinus arrhythmias; (2) First-degree AV block; (3) Mobitz type I second-degree AV block; (4) Atrial ectopic beats; and (5) Ventricular ectopic beats
Yacoub et al[18], 2012	DF/DHF/DSS	79 (8-46 yr)	35.00	ECG. ECHO. Cardiac markers	Abnormal ECG: (1) Sinus arrhythmias; (2) First-degree AV block; (3) T-wave changes; and (4) ST segment abnormalities. Systolic impairment in 45% of patients, diastolic impairment in 42%. Septal and right ventricular walls predominantly affected, worse in severe cases. 1 patient had elevated troponin I
Miranda et al[31], 2013	DF/DHF/DSS	81 (4 mo-81 yr)	14.81	Cardiac markers (troponin I and NTproBNP). ECHO. ECG. CMR	Elevated troponin I and/or NTproBNP in 14.81% of patients. 4/10 of patients had abnormal ECHO: (1) Functional abnormalities; and (2) Regional wall abnormalities. 4 patients had myocardial enhancement by CMR
Sengupta et al[32], 2013	DHF/Control	20 (DHF) (23 ± 8 yr); 20 (control) (23 ± 5 yr)	-	ECG. ECHO	LVEF reduced in DHF compared with controls (51.25 ± 0.96% vs 59.32 ± 1.26%; P = 0.032). DHF patients had: (1) Peak longitudinal strain in subendocardial region; (2) Circumferential strain in the subepicardial region; and (3) Radial strain
Yadav et al[33], 2013	DHF/DSS	67 (3 mo-14 yr)	48 (ECHO); 70 (Tei index)	ECG. ECHO. Cardiac markers	LVEF showed 48% cardiac involvement. Tei index showed 70% cardiac involvement. Tei index improved on discharge but did not normalize
Kirawittaya et al[34], 2015	DF/DHF/DSS	181 DF/DHF 35 Non-DF (< 15 yr)	14.50	ECG. ECHO. Cardiac markers	DHF patients with plasma leakage had: (1) Cardiac index (2695 vs 3188 L/min/m2); (2) LV myocardial performance index (0.413 vs 0.328); (3) Systemic vascular resistance (2478 vs 1820 dynes.s/cm-5) compared to those without plasma leakage; and (4) Cardiac dysfunction was most pronounced around the time of plasma leakage
Li et al[35], 2016	DHF/DSS	1782 (adult)	11.28	ECG. ECHO. Cardiac markers	NSD(WS+)/SD had 46.66% myocarditis. NSD(WS-) had 9.72% myocarditis. DHF with myocarditis had longer hospitalization. Prognosis of DHF patients with and without myocarditis had no significant difference
Bhatt et al[16], 2020	DHF/DSS	182 (30.2 ± 12.6 yr)	7.10	ECG. ECHO. Cardiac markers	ECG abnormality in 44/182 (24%). Cardiac markers’ elevation in 27/182 (14.83%). ECHO abnormality in 11/182 (6.04%)
Bhattacharjee et al[36], 2020	DF	84 (18-65 yr) (41 cases/43 controls)	-	ECG. ECHO. Cardiac markers	CK, CK-MB, troponin T and NT-proBNP levels in cases were higher than in controls. Troponin T was positively correlated with NTproBNP
Cabrera-Rego et al[37], 2021	DF/DHF/DSS	427 (> 18 yr)	19.70	ECG. ECHO	Rhythm disorders in 16.9%. Repolarization disorders in 3.0%. Pericarditis in 1.6%. Pericardial effusion in 0.9%. Myocarditis in 0.2%
Shah et al[38], 2021	DF	320 (> 18 yr)	35	ECG. ECHO. Cardiac markers	Sinus bradycardia in 19.7%. LVEF < 40% in 13.1%. Elevated troponin T in 15%. Elevated CK-MB in 10.6%. Elevated NTproBNP in 5.9%. Mortality rate was 4.38% with cardiac involvement

AV: Arterioventricular; CI: Cardiac index CK: Creatine kinase; CMR: Cardiac magnetic resonance; DF: Dengue fever; DHF: Dengue hemorrhagic fever; DSS: Dengue shock syndrome; ECHO: Echocardiography; EDV: End-diastolic volume; ECG: Electrocardiogram; LVEF: Left ventricular ejection fraction; NSD(WS)/SD: Non-severe dengue (warning sign)/severe dengue; SVR: Sustained virological response; VCFC/ESS: Velocity of circumferential fiber shortening adjusted for end-systolic meridional wall stress.