Electrocardiographic abnormalities and relative bradycardia in patients with hantavirus-induced nephropathia epidemica.
BACKGROUND
Nephropathia epidemica (NE), caused by Puumala virus (PUUV), is characterized by acute kidney injury (AKI) and thrombocytopenia. Cardiac involvement with electrocardiographic (ECG) abnormalities has been previously reported in NE; however, its prognostic value is unknown. Relative bradycardia is an important clinical sign in various infectious diseases, and previous smaller studies have described pulse-temperature deficit in patients with PUUV infection.


METHODS
We performed a cross-sectional survey of 471 adult patients with serologically confirmed NE. Data were collected retrospectively from medical records and prospectively at follow-up visits. Patients for whom ECGs were recorded during the acute phase of disease were enrolled retrospectively (n=263). Three patients were excluded because of documented pre-existing ECG abnormalities prior to NE. All patients with ECG abnormalities during the acute phase underwent follow-up.


RESULTS
A total of 46 patients had ECG abnormalities at the time of admission to hospital (18%). T-wave inversion was the most frequent ECG abnormality (n=31 patients), followed by ST segment changes (nine patients with elevation and six with depression). No major adverse cardiac events occurred during follow-up (median 37months; range 34-63months). Of note, ECG abnormalities reverted to normal in the majority of the patients during follow-up. During the acute phase of NE, 149 of 186 patients had relative bradycardia, without implications for disease course.


CONCLUSIONS
Transient ECG abnormalities were detected in 18% of patients during acute NE but were not associated with negative cardiovascular outcome. Relative bradycardia was identified in 80% of the patients with acute NE.
Department of Internal Medicine, Division of General Medicine and Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany.
Daniel
D
Kitterer
Division of Cardiology, Robert-Bosch-Hospital, Stuttgart, Germany.
Simon
S
Greulich
Division of Cardiology, Robert-Bosch-Hospital, Stuttgart, Germany.
Stefan
S
Grün
Division of Nephrology, University Hospital, Zurich, Switzerland.
Stephan
S
Segerer
Department of Internal Medicine, Tampere University Hospital, Tampere, Finland; School of Medicine, University of Tampere, Tampere, Finland.
Jukka
J
Mustonen
Department of Internal Medicine, Division of General Medicine and Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany.
M Dominik
MD
Alscher
Nephrology Center, Stuttgart, Germany.
Niko
N
Braun
Department of Internal Medicine, Division of General Medicine and Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany. Electronic address: joerg.latus@googlemail.com.
Joerg
J
Latus
D000208:Acute Disease; D000328:Adult; D001919:Bradycardia / Q000175:diagnosis* / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005260:Female; D005858:Germany; D006476:Orthohantavirus / Q000472:pathogenicity*; D006480:Hemorrhagic Fever with Renal Syndrome / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D011379:Prognosis; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis
Cardiac events; ECG abnormalities; Myocardial infarction; Outcome; Relative bradycardia; Stroke