Autologous Stem Cell Transplantation Improves Survival For High Risk Cardiac Amyloidosis

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3341-3341
Author(s):  
Piyanuch Kongtim ◽  
Muzaffar H. Qazilbash ◽  
Jatin J. Shah ◽  
Robert Z. Orlowski ◽  
Amir Hamdi ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
Light Chain ◽  
Cardiac Involvement ◽  
Troponin I ◽  
Troponin T ◽  
Cardiac Complications ◽  
Cardiac Responses ◽  
History Of ◽  
Related Mortality

Abstract Cardiac involvement in light chain amyloidosis (AL) predicts poor prognosis and is associated with higher treatment related mortality and morbidity during autologous stem cell transplantation (ASCT). We studied the outcomes of AL patients with cardiac involvement undergoing ASCT at our center between January 2002 and December 2012. Out of a total of 264 AL patients, 53 patients had cardiac involvement according to the International Consensus Criteria (Gertz M et al. AJH 2005) and 27 underwent ASCT. Cardiac staging was assessed using the Revised Prognostic Staging System for Light Chain Amyloidosis (Kumar S et al, JCO 2012). Hematologic and cardiac responses were evaluated before and at 1 year after ASCT using the guidelines established by the 10th International Symposium on Amyloid and Amyloidosis (Gertz M et al. AJH 2005). The median age of the patients was 53 years (range 36-74) with a median duration from diagnosis to ASCT of 6 months (range 3-95). The estimated median follow up for the entire cohort was 41 months (range 6-173). Twenty-four patients (89%) had an additional organ involvement, besides heart. Cardiac stage ≥3 was seen in 14 patients. The median troponin-T, Troponin-I, BNP and NT-proBNP levels and free light chain difference (FCL-diff) were 0.054 ng/ml, 0.05 ng/ml, 376 pg/ml, 1888 pg/ml, and 116.4 mg/l respectively (table1). Twenty-four patients (89%) received induction chemotherapy and 22 of those (81%) received novel chemotherapy agents. Eighteen patients (66.6%) achieved at least PR prior to ASCT. Four patients (14.8%) received reduced doses melphalan conditioning (140-180 mg/m2). One-year transplant related mortality (TRM) was 3.7% (1 patient died at day 11 post-transplant due to cardiac event). At 1-year post ASCT, overall HR was seen in 24 patients (89%) (CR=26% and PR=63%) while 3 patients (11%) had cardiac responses. At the time of last follow up, 17 patients (63%) were alive. The median overall survival (OS) from diagnosis and from ASCT was 58 months (95% CI; 46-69) and 46 months (95% CI; 36-55) respectively (figure1). The median progression free survival (PFS) was 25 months (95% CI; 6-44). Cumulative incidence of hematologic relapse at 3 year was 38.5% (95%CI 23.7-62.5). Cardiac progression at last follow up was seen in 1 patient (3.7%). Negative factors affecting OS included lack of induction therapy prior to ASCT and NT-proBNP more than 5000 pg/ml. We conclude that ASCT is well tolerated in patients with high-risk cardiac amyloidosis and the incorporation of induction therapy can improve overall outcomes of these patients.Figure1.Overall SurvivalFigure1. Overall SurvivalTable1Patient CharacteristicsBaseline characteristicsTotal (N=27)Interquartile rangeMedian age (year)5336-71Gender: male (%)20 (74.1)Median time from diagnosis to transplant, (month)63-95Receive induction chemotherapy (%)24 (88.9)Receive novel induction chemotherapy (%)22 (81.5)Light chain type (%)-Kappa-Lambda.6 (22.2) 21 (77.8)Other organ involvement (%)24 (88.9)History of cardiac complications prior ASCT (%)17 (63)History of cardiac complications after ASCT (%)20 (74.1)ICU admission prior ASCT (%)3 (11.1)Cardiac event prior ASCT (%)17 (62.9%)Median FLC-diff (mg/l) (N=15)116.415-1168Median EF (%) (N=19)6030-82Median IVS (mm.) (N=14)1.350.7-2.1Median Troponin-T (ng/ml) (N=20)0.0190.01-0.22Median Troponin-I (ng/ml) (N=19)0.060.03-9.09Median BNP (pg/ml) (N=23)37615.2-1782Median NT-proBNP (pg/ml) (N=12)1888.519-9911Median serum calcium (mg/dl)9.27-11Median serum albumin (g/dl)3.92.4Median Creatinine (mg/dl)1.01-9Median B2 microglobulin (mg/l)3.151-15Median 24-hr urine protein (mg)574120-36006Median serum M protein (g/dl)0.50-4Median LDH (IU/l)377146-770Median BM plasma cell (%)110-58Cardiac stage at diagnosis.Stage 11Stage 25Stage 36Stage 48Cardiac stage at transplant.Stage 13Stage 25Stage 34Stage 46 Disclosures: No relevant conflicts of interest to declare.

Botezomib Containing Regimens Provide a Rapid Hematological and Cardiac Response in Patients with AL Amyloidosis

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4064-4064
Author(s):  
Victor H Jimenez-Zepeda ◽  
Donna Reece ◽  
Suzanne Trudel ◽  
Christine I. Chen ◽  
Rodger E. Tiedemann ◽  
...  
Keyword(s):  
Research Funding ◽  
Cardiac Involvement ◽  
Troponin I ◽  
Cardiac Biomarkers ◽  
Cardiac Response ◽  
Cardiac Complications ◽  
Al Amyloidosis ◽  
Novel Therapy ◽  
Cardiac Reserve ◽  
Cardiac Responses

Abstract Abstract 4064 The spectrum and severity of organ involvement, especially cardiac involvement, usually dictate early outcome, with cardiac biomarkers such as cTnT, NT-ProBNP, and serum uric acid; median survival is only 5.8 months in patients (pts) with high-stage cardiac biomarkers. Since novel therapies have been now been tried in AL amyloidosis, we performed a retrospective review of two different treatment approaches to explore whether the more rapid hematological (HR) that can result from novel therapy produces improved cardiac responses (CardR) and organ responsse (OR) and translates into a greater benefit for pts with poor cardiac reserve. Methods: Pts with documented symptomatic AL with cardiac involvement based on functional studies and/or serum biomarkers who received treatment with bortezomib–containing (Bor) regimens or melphalan and dexamethasone (MD) were identified from our institutional amyloidosis database. TnI and BNP values at baseline, 3, 6 and 12 months were recorded. HR, CardR and OR were assessed according to the more recent validation of the criteria response (Leukemia, 2012). Results: Thirty-eight pts meeting inclusion criteria were identified, with 25 pts treated with Bor and 13 pts treated with MD from 12/2005 to 10/2011. Clinical characteristics are shown in Table 1. Bor was given as upfront therapy in 9 pts, as second-line in 13 pts and third-line in 3. After a median of 7 cycles of Bor regimens (1–56) and 6 cycles of MD (1–9), a HR was seen in 23 cases (92%) and 13 cases (100%), including: CR in 32% and 31%, VGPR in 56% and 54% and PR in 4% and 15%, respectively, (p=0.491). Pts treated with Bor achieved HR at a median of 6 weeks compared to 10 weeks for MD (p=0.001); 16 patients treated with Bor had already achieved ≥PR at 6 weeks. OR at 6 months was documented in 20 cases treated with Bor (80%) and 3 cases with MD (23%). With respect to cardiac response, a ≥50% decrease of Troponin-I was seen in 9 of 13 and 4 of 11 evaluable patients treated with Bor and MD respectively, while a decrease of BNP of ≥50% was observed in 11 of 13 evaluable cases treated with Bor and 10 of 13 treated with MD at a median of 6 and 5 months in the Bor group and 12 and 12 months in the MD group, respectively (p=0.001). In the Bor group, 23 patients remained progression-free, versus 7 patients in the MD group (p=0.01). In conclusion, Bor is a safe and well-tolerated therapy for AL patients and shows faster HR and cardiac responses assessed by BNP and TnI than MD. Although this retrospective study has the limitations of selection bias, small numbers, variable entry criteria, and slight differences in treatment regimen, we show that the overall HR and OR rates are similar with both Bor and MD regimens but, importantly, the rapidity of response is better with bortezomib therapy. This is meaningful for patients with poor cardiac reserve in whom a fast response is needed to avoid cardiac complications/early death. Further prospective comparative studies are required with a focus on longer-term outcomes such as overall survival. Disclosures: Jimenez-Zepeda: MMRF: Research Funding; Janssen Ortho: Honoraria. Reece:Otsuka: Honoraria, Research Funding; Janssen: Consultancy, Honoraria, Research Funding; Celgene: Consultancy, Honoraria, Research Funding; Bristol Myers Squibb: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Millinneum Pharmaceuticals: Research Funding; Merck: Consultancy, Honoraria, Research Funding. Chen:Roche: Honoraria; Johnson & Johnson, Lundbeck, Celgene: Consultancy; Johnson & Johnson, Celgene, GlaxoSmithKline: Research Funding. Tiedemann:Janssen: Honoraria; Celgene: Honoraria. Kukreti:Roche: Honoraria.

Cardiac cephalalgia: severe, non-exertional headache presenting as unstable angina

2018 ◽  
Vol 19 (2) ◽  
pp. 173-175
Author(s):  
Jonathan Lazari ◽  
Andrew Money-Kyrle ◽  
Benjamin R Wakerley
Keyword(s):  
Clinical Characteristics ◽  
Troponin I ◽  
Coronary Intervention ◽  
Severe Stenosis ◽  
Exertional Headache ◽  
Percutaneous Coronary ◽  
History Of ◽  
St Elevation ◽  
Cardiac Cephalalgia

Cardiac cephalalgia is a migraine-like headache that occurs during episodes of myocardial ischaemia. Clinical characteristics of the headache vary widely but are often severe in intensity, worsen with reduced myocardial perfusion and resolve with reperfusion. It can present along with typical symptoms of angina pectoris, although not always. We present a 64-year-old man with a 6-month history of severe, non-exertional headaches occurring with increasing frequency. A resting ECG showed ST elevation in the inferior leads. His serum troponin I was not elevated. Coronary angiography showed severe stenosis of his right coronary artery, which was successfully stented by percutaneous coronary intervention. He remains headache free at 2-year follow-up.

scholarly journals Cardiac Troponin T Predicts Long-Term Outcomes in Hemodialysis Patients

2001 ◽  
Vol 47 (3) ◽  
pp. 412-417 ◽  
Author(s):  
Daylily S Ooi ◽  
Deborah Zimmerman ◽  
Janet Graham ◽  
George A Wells
Keyword(s):  
Troponin I ◽  
Troponin T ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Peripheral Vascular ◽  
Long Term Outcomes ◽  
All Cause Mortality ◽  
End Stage

Abstract Background: Increased plasma troponin T (cTnT), but not troponin I (cTnI), is frequently observed in end-stage renal failure patients. Although generally considered spurious, we previously reported an associated increased mortality at 12 months. Methods: We studied long-term outcomes in 244 patients on chronic hemodialysis for up to 34 months, correlating the outcomes to plasma cTnT in routine predialysis samples. In addition, subsequent plasma samples at least 1 year later and within 6 months of data analysis were available in 97 patients and were used to identify patients with increasing plasma cTnT. The endpoints used were death and new or worsening coronary, cerebro-, and peripheral vascular disease and neuropathy. Results: Transplantation occurred more frequently in patients with low initial cTnT: 31%, 13%, and 3% in the groups with cTnT <0.010, 0.010–0.099, and ≥0.100 μg/L, respectively. In the same groups, total deaths occurred in 6%, 43%, and 59% and cardiac deaths in 0%, 14%, and 24% of patients. In patients with follow-up samples, the group with increasing cTnT had a significantly increased death (relative risk, 2.0; P = 0.028). The increase was mainly in cardiac and sudden deaths. Conclusions: Higher plasma cTnT predicts long-term all-cause mortality in hemodialysis patients, even at concentrations <0.100 μg/L, as does an increasing cTnT concentration over time.

scholarly journals Revisiting the Natural History of Pulmonary Tuberculosis: A Bayesian Estimation of Natural Recovery and Mortality Rates

2020 ◽  
Author(s):  
Romain Ragonnet ◽  
Jennifer A Flegg ◽  
Samuel L Brilleman ◽  
Edine W Tiemersma ◽  
Yayehirad A Melsew ◽  
...  
Keyword(s):  
Natural History ◽  
Credible Interval ◽  
Mortality Rates ◽  
Previous Systematic Review ◽  
Secondary Infections ◽  
Specific Mortality ◽  
History Of ◽  
Smear Negative ◽  
Related Mortality

Abstract Background Tuberculosis (TB) natural history remains poorly characterized, and new investigations are impossible as it would be unethical to follow up TB patients without treatment. Methods We considered the reports identified in a previous systematic review of studies from the prechemotherapy era, and extracted detailed data on mortality over time. We used a Bayesian framework to estimate the rates of TB-induced mortality and self-cure. A hierarchical model was employed to allow estimates to vary by cohort. Inference was performed separately for smear-positive TB (SP-TB) and smear-negative TB (SN-TB). Results We included 41 cohorts of SP-TB patients and 19 cohorts of pulmonary SN-TB patients in the analysis. The median estimates of the TB-specific mortality rates were 0.389 year−1 (95% credible interval [CrI], .335–.449) and 0.025 year−1 (95% CrI, .017–.035) for SP-TB and SN-TB patients, respectively. The estimates for self-recovery rates were 0.231 year−1 (95% CrI, .177–.288) and 0.130 year−1 (95% CrI, .073–.209) for SP-TB and SN-TB patients, respectively. These rates correspond to average durations of untreated TB of 1.57 years (95% CrI, 1.37–1.81) and 5.35 years (95% CrI, 3.42–8.23) for SP-TB and SN-TB, respectively, when assuming a non-TB-related mortality rate of 0.014 year−1 (ie, a 70-year life expectancy). Conclusions TB-specific mortality rates are around 15 times higher for SP-TB than for SN-TB patients. This difference was underestimated dramatically in previous TB modeling studies, raising concerns about the accuracy of the associated predictions. Despite being less infectious, SN-TB may be responsible for equivalent numbers of secondary infections as SP-TB due to its much longer duration.

scholarly journals Use of Cardiac Biomarkers for Monitoring Improvement of Left Ventricular Function by Immunoadsorption Treatment in Dilated Cardiomyopathy

Biomolecules ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. 654
Author(s):  
Weinmann ◽  
Werner ◽  
Koenig ◽  
Rottbauer ◽  
Walcher ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Troponin I ◽  
Troponin T ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Lv Function ◽  
Long Term Follow Up ◽  
Acute Changes

Immunoadsorption and subsequent administration of intravenous immunoglobulin (IVIG) have shown beneficial effects on cardiac function and symptoms in patients with dilated cardiomyopathy. Biomarkers play an emerging role in disease monitoring and outcome prediction of heart failure (HF) patients. We aimed to analyze cardiac biomarkers as predictor for improvement of left ventricular (LV) function after immunoadsorption treatment in dilated cardiomyopathy (DCM). Thirty-one patients with dilated cardiomyopathy on optimized HF pharmacotherapy received a single cycle of immunoadsorption for five days followed by IVIG administration. Left ventricular ejection fraction (LVEF) and heart failure biomarkers (hs troponin T, hs troponin I, NT-proBNP and sST2) were evaluated before treatment, after the last cycle of immunoadsorption and during a median follow-up of 30.5 months. We correlated HF biomarkers before immunoadsorption and acute changes of HF biomarkers by immunoadsorption with LV improvement during the long-term follow-up. LV function improved significantly after immunoadsorption from 28.0 to 42.0% during the long-term follow-up (p < 0.0001). Evaluation of biomarker levels showed a significant decrease for hs troponin I (from 9.2 to 5.5 ng/L, p < 0.05) and NT-proBNP (from 789.6 to 281.2 pg/mL, p < 0.005). Correlation of biomarker levels before immunoadsorption and LVEF at the long-term follow-up show good results for hs troponin T (r = −0.40, r2 = 0.16, p < 0.05), hs troponin I (r = −0.41, r2 = 0.17, p < 0.05) and sST2 (r = −0.46, r2 = 0.19, p < 0.05). Correlation of biomarker levels before immunoadsorption and the individual increase in LV function was significant for hs troponin T (r = −0.52, r2 = 0.27, p < 0.005) and hs troponin I (r = −0.53, r2 = 0.29, p < 0.005). To imply a tool for monitoring outcome immediately after immunoadsorption treatment, we investigated the correlation of acute changes of biomarker levels by immunoadsorption treatment and individual increase in LV function. A drop in hs troponin T (r = −0.41, r2 = 0.17, p < 0.05) and hs troponin I (r = −0.53, r2 = 0.28, p < 0.005) levels demonstrate a good correlation to improvement in LVEF during the long-term follow-up. Conclusion: Hs troponin T and I levels correlate with LV function improvement during long-term follow-up. Acute decrease of troponins by immunoadsorption treatment is paralleled by individual improvement of LVEF at the long-term follow-up. Thus, troponins could serve as a monitoring tool for the improvement of LV function after immunoadsorption treatment in dilated cardiomyopathy.

scholarly journals Effects of temperature and method of heat treatment on myofibrillar proteins of pork

2014 ◽  
Vol 20 (3) ◽  
pp. 407-415 ◽  
Author(s):  
Dragan Vujadinovic ◽  
Radoslav Grujic ◽  
Vladimir Tomovic ◽  
Aleksandra Torbica
Keyword(s):  
Heat Treatment ◽  
Light Chain ◽  
Myosin Light Chain ◽  
Troponin I ◽  
Troponin T ◽  
Protein S ◽  
Treatment Temperature ◽  
M Protein ◽  
Meat Sample ◽  
Myofibrillar Proteins

During the tests in this paper, meat processing was carried out at different temperatures between the range of 51?C to 100?C. The meat was processed by dry heat (roasting) and wet heat treatments (cooking) in water at atmospheric pressure. After heat treatment, myofibrillar proteins were extracted from solutions at constant ionic strength. Quantitative and qualitative determinations of protein?s fractions were performed by capillary electrophoresis. Myofibrillar proteins were also analized for fresh pork meat sample. Results obtained in fresh meat were compared with those recorded after roasting and cooking. In the fresh and thermally processed pork the following proteins were identified: myosin, light chain 3; myosin, light chain 2; troponin - C; troponin - I; myosin, light chain 1; tropomyosin; troponin - T; actin; desmin; ? - actinin; C - protein; M - protein (M?); M - protein (M?); heavy meromyosin - HMM. For both methods of thermal processing, with increasing heat treatment temperature, concentration of soluble protein in the extract decreases rapidly after 51?C. Cooking treatment had a more intense effect on the proteins change and denaturation than roasting.

Immunocytochemical investigations of muscle differentiation in the Atlantic herring (Clupea harengus: Teleostei)

1994 ◽  
Vol 74 (1) ◽  
pp. 79-91 ◽  
Author(s):  
I. A. Johnston ◽  
Z. Horne
Keyword(s):  
Light Chain ◽  
Myosin Light Chain ◽  
Troponin I ◽  
Troponin T ◽  
Small Diameter ◽  
Fibre Volume ◽  
Clupea Harengus ◽  
Muscle Fibres ◽  
Atlantic Herring ◽  
Superficial Muscle

The myotomes in yolk-sac larvae of the Atlantic herring (Clupea harengus: Teleostei) contain a single layer of small-diameter superficial muscle fibres surrounding an inner mass of around 280 larger-diameter muscle fibres. The fraction of muscle fibre volume occupied by mitochondria is dependent on temperature, and in larvae reared at 8°C was 41% for the superficial fibres, and 25% for the inner muscle fibres. The inner muscle fibres of larvae share some myofibrillar proteins with adult white muscle, but contain unique isoforms of myosin heavy chains, troponin T, troponin I and myosin light chain 2. A monoclonal antibody has been produced which is specific to myosin light chain 3 (MLC3). Immunocytochemical studies have shown that the expression of MLC3 is switched off in the superficial muscle fibres at the start of metamorphosis when larvae reach 28–30 mm total length (TL). Metamorphosis to the juvenile stage is complete in fish 35–40 mm TL and is also associated with the development of gill filaments and the production of presumptive slow muscle fibres which form externally to the larval superficial muscle fibres in the region of the lateral line nerve.

scholarly journals Immunoglobulin D amyloidosis: a distinct entity

Blood ◽  
2012 ◽  
Vol 119 (1) ◽  
pp. 44-48 ◽  
Author(s):  
Morie A. Gertz ◽  
Francis K. Buadi ◽  
Suzanne R. Hayman ◽  
David Dingli ◽  
Angela Dispenzieri ◽  
...  
Keyword(s):  
Light Chain ◽  
Monoclonal Gammopathy ◽  
Cardiac Involvement ◽  
Distinct Entity ◽  
Monoclonal Protein ◽  
Light Chain Amyloidosis ◽  
Clinical Syndromes ◽  
Immunoglobulin D ◽  
History Of ◽  
Monoclonal Proteins

Abstract IgD monoclonal gammopathies are uncommon. They are seen rarely as a monoclonal gammopathy of undetermined significance and are present in 1%-2% of patients with multiple myeloma. In light-chain amyloidosis, IgD monoclonal proteins are found in ap-proximately 1% of patients. When an IgD monoclonal protein is found, amyloidosis is often omitted from the differential diagnosis. In the present study, we reviewed the natural history of IgD-associated amyloidosis among 53 patients seen over 41 years. The distribution of clinical syndromes suggests that these patients have a lower frequency of renal and cardiac involvement. The overall survival of these patients does not appear to be different from that of patients who have light-chain amyloidosis associated with another monoclonal protein.

scholarly journals Clinical, Cardiological and Serologic Follow-Up of Chagas Disease in Children and Adolescents from the Amazon Region, Brazil: Longitudinal Study

2020 ◽  
Vol 5 (3) ◽  
pp. 139
Author(s):  
Ana Neves Pinto ◽  
Vera Valente ◽  
Sebastião Valente ◽  
Tamires Motta ◽  
Ana Ventura
Keyword(s):  
Children And Adolescents ◽  
Chagas Disease ◽  
Acute Phase ◽  
Cardiac Involvement ◽  
Cardiac Injury ◽  
Antibody Test ◽  
Amazon Region ◽  
Cardiac Complications ◽  
Epidemiologic Profile

Background: Outbreaks of Chagas disease (CD) by foodborne transmission is a problem related to deforestation, exposing people to triatomines infected by T. cruzi, in the Amazon region. Once involving long-time follow-up, the treatment efficacy of the CD during its acute phase is still unknown. The authors aim to describe the clinical and epidemiologic profile of children and adolescents with CD, as well as treatment and cardiac involvement during the follow-up. Methods: A descriptive cohort study was conducted from 1998 to 2013 among children and adolescents up to 18 years-old with confirmed diagnosis of CD. All participants met the criteria of CD in the acute phase. Results: A total of 126 outpatients were included and received treatment and follow-up examinations during a medium period of 10.9 years/person. Most of them (68.3%) had their diagnosis established during oral transmission outbreaks. The diagnostic method with the most positive results rate (80.9%) was the IgM class anti-T. cruzi antibody test as an acute phase marker, followed by the thick blood smears (60.8%). Acute myopericarditis was demonstrated in 18.2% of the patients, most of them with favorable evolution, though 2.4% (3/126) persisted with cardiac injury observed at the end point of the follow-up. Conclusions: Antibodies against T. cruzi persisted in 54.8% of sera from the patients without prognostic correlation with cardiac involvement. Precocious treatment can decrease potential cardiac complications and assure good treatment response, especially for inhabitants living in areas with difficult accessibility.

Cardiac evaluation in adults with dengue virus infection by serial echocardiography

2020 ◽  
Author(s):  
Chayasin Mansanguan ◽  
Borimas Hanboonkunupakarn ◽  
Sant Muangnoicharoen ◽  
Arun Huntrap ◽  
Akkapon Poolcharoen ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Virus Infection ◽  
Dengue Virus ◽  
Cardiac Function ◽  
Cardiac Involvement ◽  
Troponin T ◽  
Left Ventricular ◽  
Dengue Virus Infection ◽  
Cardiac Biomarker

Abstract Background Dengue virus infection (DVI) is a major health problem in many parts of the world. Its manifestations range from asymptomatic infections to severe disease. Although cardiac involvement has been reported in DVI, its incidence has not yet been well established. Methods From July 2016 to January 2018, patients hospitalized at the Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, with dengue virus infection confirmed by positive NS1 or positive dengue immunoglobulin M findings, participated in the study. We characterized the incidence and change in cardiac function by serial echocardiography and levels of troponin-T and creatinine kinase-myocardial band (CK-MB) on the day of admission, the day of defervescence, the first day of hypotension (if any), and at 2-week follow-up. Results Of the 81 patients evaluated, 6 (7.41%) exhibited elevated biomarker levels. There was no difference in clinical presentation amongst dengue fever, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) except the amount of bleeding. Cardiac involvement was found in 22% of patients: 3 (3.70%) had left ventricular systolic dysfunction, 3 (3.70%) had transient diastolic dysfunction, 6 (7.41%) had increased levels of at least one cardiac biomarker (troponin-T or CK-MB), and 6 (7.41%) had small pericardial effusion. Myocarditis was suspected in only two patient (with DHF); thus, myocarditis was uncommon in patients with dengue virus infection. Three patients developed DSS during admission and transfer to the intensive care unit. Conclusion Cardiac involvement in adults with dengue infection was found in 22.22% of cases, ranging from elevated cardiac biomarker, transient left ventricular systolic and diastolic dysfunction and pericardial effusion. We found that DHF was the significant risk factor for cardiac involvement (p < 0.001). Abnormalities in cardiac function had resolved spontaneously by the day of follow-up without specific treatment.

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