title: Evaluation of Cardiac Involvement in Children with Dengue by Serial Echocardiographic Studies.
abstract: BACKGROUND
  Infection with dengue virus results in a wide range of clinical manifestations from dengue fever (DF), a self-limited febrile illness, to dengue hemorrhagic fever (DHF) which is characterized by plasma leakage and bleeding tendency. Although cardiac involvement has been reported in dengue, the incidence and the extent of cardiac involvement are not well defined.
  
  
  RESULTS
  We characterized the incidence and changes in cardiac function in a prospective in-patient cohort of suspected dengue cases by serial echocardiography. Plasma leakage was detected by serial chest and abdominal ultrasonography. Daily cardiac troponin-T levels were measured. One hundred and eighty one dengue cases were enrolled. On the day of enrollment, dengue cases that already developed plasma leakage had lower cardiac index (2695 (127) vs 3188 (75) (L/min/m2), p = .003) and higher left ventricular myocardial performance index (.413 (.021) vs .328 (.026), p = .021) and systemic vascular resistance (2478 (184) vs 1820 (133) (dynes·s/cm5), p = .005) compared to those without plasma leakage. Early diastolic wall motion of the left ventricle was decreased in dengue cases with plasma leakage compared to those without. Decreased left ventricular wall motility was more common in dengue patients compared to non-dengue cases particularly in cases with plasma leakage. Differences in cardiac function between DF and DHF were most pronounced around the time of plasma leakage. Cardiac dysfunction was transient and did not require treatment. Transient elevated troponin-T levels were more common in DHF cases compared to DF (14.5% vs 5%, p = 0.028).
  
  
  CONCLUSIONS
  Transient left ventricular systolic and diastolic dysfunction was common in children hospitalized with dengue and related to severity of plasma leakage. The functional abnormality spontaneously resolved without specific treatment. Cardiac structural changes including myocarditis were uncommon.
authors.affiliation: Queen Sirikit National Institute of Child Health, Bangkok, Thailand.
authors.forename: Tawatchai
authors.initials: T
authors.lastname: Kirawittaya
authors.affiliation: Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
authors.forename: In-Kyu
authors.initials: IK
authors.lastname: Yoon
authors.affiliation: Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
authors.forename: Sineewanlaya
authors.initials: S
authors.lastname: Wichit
authors.affiliation: Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America.
authors.forename: Sharone
authors.initials: S
authors.lastname: Green
authors.affiliation: Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America.
authors.forename: Francis A
authors.initials: FA
authors.lastname: Ennis
authors.affiliation: United States Army Institute of Surgical Research, Institute of Surgical Research, Houston, Texas, United States of America.
authors.forename: Robert V
authors.initials: RV
authors.lastname: Gibbons
authors.affiliation: Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Thomas
authors.affiliation: Institute for Immunology and Informatics, University of Rhode Island, Providence, Rhode Island, United States of America.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Rothman
authors.affiliation: Queen Sirikit National Institute of Child Health, Bangkok, Thailand.
authors.forename: Siripen
authors.initials: S
authors.lastname: Kalayanarooj
authors.affiliation: Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America.
authors.forename: Anon
authors.initials: A
authors.lastname: Srikiatkhachorn
mesh_terms: D002648:Child; D003715:Dengue / Q000150:complications* / Q000453:epidemiology; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008297:Male; D013997:Time Factors