Myocardial depression in dengue hemorrhagic fever: Prevalence and clinical description*

Abstract

OBJECTIVES: To determine the prevalence of myocardial depression and its effect on the clinical severity in patients with dengue hemorrhagic fever. DESIGN: Clinical study. SETTING: King Chulalongkorn Memorial Hospital, Bangkok, Thailand. PATIENTS: Ninety-one children (age 10.5 +/- 2.9 yrs, male/female = 52/39) with serologically or polymerase chain reaction-proven dengue virus infection. INTERVENTIONS: Left ventricular ejection fraction (EF) was measured. The proportions of patients with EF <50% were identified in patients with dengue fever (DF, n = 30), dengue hemorrhagic fever without shock (DHF, n = 36), and dengue shock syndrome (DSS, n = 25). Comparisons of clinical findings were made among DSS patients with depressed ventricular function (EF <50%), fair ventricular function (EF > or =50% and <60%), and good ventricular function (EF > or = 60%). Serum troponin T was analyzed in nine patients. MEASUREMENTS AND MAIN RESULTS: EF during toxic stage was significantly lower in patients with DSS than DHF, and lower in DHF than DF (p = .05) with rapid recovery within 24-48 hrs. EF <50% was found in 6.7%, 13.8%, and 36% of patients with DF, DHF, and DSS during the toxic stage, respectively (p = .01). DSS patients with poor ventricular function had significantly more tachycardia and hepatomegaly. While end-diastolic volumes were similarly reduced, patients with lower EF tended to have lower cardiac output, required more aggressive intravenous fluid resuscitation, developed larger pleural effusion, and had higher incidence of respiratory embarrassment. No patient had elevated troponin T level. CONCLUSIONS: Transient myocardial depression is not uncommon in patients with DSS. Cardiac dysfunction in children with DSS may contribute to the clinical severity and the degree of fluid overload in these patients.