Hemodynamic profiles of patients with dengue hemorrhagic fever during toxic stage: an echocardiographic study.
OBJECTIVE
To study left ventricular performance and hemodynamic abnormalities during different stages of dengue hemorrhagic fever (DHF).


METHODS
Observational study in a tertiary medical school hospital.


METHODS
Twenty-four patients with serologically confirmed diagnosis of dengue virus infection and DHF according to the WHO criteria.


METHODS
Echocardiography was performed during toxic, convalescent stages and at least 2 weeks after discharge (recovery). Left ventricular ejection fraction, rate-corrected velocity of circumferential fiber shortening adjusted for end-systolic meridional wall stress (VCFC/ESS) Z score, end-diastolic volume Z score, cardiac index, heart rate, mean arterial pressure, and total systemic vascular resistance (SVR) were compared between different stages of DHF.


RESULTS
Ejection fraction and VCFC/ESS were significantly lower during the toxic stage than after recovery. End-diastolic volume was low during toxic stage and returned to normal during convalescence and recovery. Cardiac index was low during the toxic stage due to decreased preload (low end-diastolic volume) and depressed left ventricular ejection fraction. Cardiac index remained subnormal during convalescence due to sinus bradycardia. Wide variation in heart rate during toxic stage resulted in a small, nonsignificant increase compared to recovery. With treatment, heightened SVR resulted in relatively normal mean arterial pressure throughout the course of the illness.


CONCLUSIONS
The mechanism of decreased cardiac output during toxic stage of DHF is complex. Decreased preload is accompanied by decreased left ventricular performance, and possibly a subnormal heart rate response in some patients.
Khongphatthanayothin
Apichai
A
Chulalongkorn Hospital, Rama IV Road, Pratumwan, 10330, Bangkok, Thailand. apichaik@yahoo.com
Suesaowalak
Monnipa
M
Muangmingsook
Sunthorn
S
Bhattarakosol
Parvapan
P
Pancharoen
Chitsanu
C
D000704:Analysis of Variance; D002306:Cardiac Volume; D002648:Child; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D019595:Severe Dengue / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*