Cardiovascular sequelae of dengue fever: a systematic review

ABSTRACT

Introduction

Dengue is one of the most important viral diseases globally and a majority of symptomatic infections result in a benign course. However, a small number of patients develop severe manifestations, including the cardiovascular (CV) manifestations, including myocardial impairment, arrhythmias, and fulminant myocarditis.

Areas covered

Electronic databases, including PubMed/MEDLINE, EMBASE, Scopus, and CINAHL were searched for articles incorporating CV manifestations of dengue fever (DF).

Expert opinion

Included studies involved 6,773 patients, and 3,122 (46.1%) exhibited at least one cardiac manifestation. Electrocardiogram (ECG) abnormalities (30.6%) included sinus bradycardia (8.8%), nonspecific ST-T changes (8.6%), ST depression (7.9%), and T-wave inversion (2.3%). Mechanical sequelae were present in 10.4%, including left ventricular (LV) systolic dysfunction (5.7%), and myocarditis (2.9%). Pericardial involvement was noted as pericarditis (0.1%), pericardial effusion (1.3%), and pericardial tamponade (0.1%). Apart from that, the cardiac injury was depicted through a rise in cardiac enzymes (4.5%). The spectrum of CV manifestations in dengue is broad, ranging from subtle ST-T changes to fulminant myocarditis and the use of contemporary techniques in diagnosing cardiac involvement should be employed for rapid diagnosis and treatment.

KEYWORDS:

• Aedes aegypti
• dengue shock syndrome
• dengue hemorrhagic fever
• pseudoaneurysm
• myocarditis

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Article highlights

• Dengue is one of the most important viral diseases globally and it presents with variable disease course.

• Eighty-six articles involving 6,773 patients were extracted which demonstrated at least one cardiovascular manifestation in 3,122 (46.1%) patients.

• These manifestations can be a cause of hemodynamic collapse during the critical phase of capillary leakage.

• Use of conventional techniques in diagnosing cardiac involvement should be employed for rapid diagnosis and treatment in dengue fever.

Author contribution

AR: first draft; AH: first draft; UI: concept, literature search; JM: final draft, figures, tables, supervision; SMJZ: final draft; HK: methodology; AM: literature search; DIS: concept, methodology; HN: first drat, final draft

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14779072.2022.2082945

Additional information

Funding

This paper was not funded.