Transient cardiac injury during H7N9 infection
Jie Han
Department of Cardiovascular Sciences, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Search for more papers by this authorYun Mou
Department of Ultrasound, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Search for more papers by this authorDong Yan
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
Search for more papers by this authorYun-Tao Zhang
Department of Intensive Care Unit, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Search for more papers by this authorTian-An Jiang
Department of Ultrasound, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Search for more papers by this authorYuan-Yuan Zhang
Department of Cardiovascular Sciences, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Search for more papers by this authorYi-Jiang Zhou
Department of Cardiovascular Sciences, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Search for more papers by this authorZe-Wei Sun
Department of Cardiovascular Sciences, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Search for more papers by this authorDong-Mei Jiang
Department of Cardiology, Biomedical Research (therapy) center, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
Search for more papers by this authorYan Chen
Department of Ultrasound, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Search for more papers by this authorCorresponding Author
Wei-Feng Liang
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
Correspondence to: Dr Wei-Feng Liang, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, China. Tel.: 86-571-87236458; fax: 86-571-87236459; e-mail: [email protected]
Or
Dr Lan-Juan Li, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, China. Tel.: 86-571-87236458; fax: 86-571-87236459; e-mail: [email protected]
Search for more papers by this authorCorresponding Author
Lan-Juan Li
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
Correspondence to: Dr Wei-Feng Liang, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, China. Tel.: 86-571-87236458; fax: 86-571-87236459; e-mail: [email protected]
Or
Dr Lan-Juan Li, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, China. Tel.: 86-571-87236458; fax: 86-571-87236459; e-mail: [email protected]
Search for more papers by this authorJie Han
Department of Cardiovascular Sciences, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Search for more papers by this authorYun Mou
Department of Ultrasound, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Search for more papers by this authorDong Yan
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
Search for more papers by this authorYun-Tao Zhang
Department of Intensive Care Unit, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Search for more papers by this authorTian-An Jiang
Department of Ultrasound, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Search for more papers by this authorYuan-Yuan Zhang
Department of Cardiovascular Sciences, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Search for more papers by this authorYi-Jiang Zhou
Department of Cardiovascular Sciences, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Search for more papers by this authorZe-Wei Sun
Department of Cardiovascular Sciences, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Search for more papers by this authorDong-Mei Jiang
Department of Cardiology, Biomedical Research (therapy) center, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
Search for more papers by this authorYan Chen
Department of Ultrasound, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Search for more papers by this authorCorresponding Author
Wei-Feng Liang
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
Correspondence to: Dr Wei-Feng Liang, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, China. Tel.: 86-571-87236458; fax: 86-571-87236459; e-mail: [email protected]
Or
Dr Lan-Juan Li, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, China. Tel.: 86-571-87236458; fax: 86-571-87236459; e-mail: [email protected]
Search for more papers by this authorCorresponding Author
Lan-Juan Li
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
Correspondence to: Dr Wei-Feng Liang, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, China. Tel.: 86-571-87236458; fax: 86-571-87236459; e-mail: [email protected]
Or
Dr Lan-Juan Li, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, China. Tel.: 86-571-87236458; fax: 86-571-87236459; e-mail: [email protected]
Search for more papers by this authorAbstract
Background
Recent reports have characterized virological and clinical features of the novel reassortant avian-origin influenza A (H7N9) virus. However, cardiovascular involvement during H7N9 infection is still unclear. In this study, we evaluate cardiac injury among H7N9-infected patients.
Materials and Methods
A total of 40 patients who were laboratory-confirmed with H7N9 infection were retrospectively included and grouped by Acute Physiology and Chronic Health Evaluation II (APACHE II) score into four subgroups I(0–10), II(11-20), III(21-30) and IV(31-71). Cardiovascular complications and markers of cardiac injury including creatinine kinase (CK), CK iso-enzyme (CK-MB), cardiac troponin I (cTNI) and brain natriuretic peptide (BNP) were assessed. Electrocardiogram (ECG) and echocardiography (ECHO) were also performed.
Results
Half of patients manifested with cardiovascular complications, with hypotension (47·5%) and heart failure (40·0%) the most prevalent. CK, CK-MB and cTNI showed marked increase with H7N9 virus infection but significantly decreased after H7N9 viral tests turned negative. More than half of patients presented with an abnormal ECG, but most of them are benign changes. ECHO examination showed different degree of impairment of cardiac function. Pulmonary artery systolic pressure was increased in all groups. Cardiac damage was more evident in patients with higher APACHE II score.
Conclusions
H7N9 virus exerts a transient impairment on the cardiovascular system. Patients with a higher APACHE II score are more susceptible to cardiac damage.
Supporting Information
Filename | Description |
---|---|
eci12386-sup-0001-VideoS1.avivideo/avi, 1.7 MB | Video S1. RV free wall LS was measured by 2-dimensional strain analysis. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
References
- 1Gao R, Cao B, Hu Y, Feng Z, Wang D, Hu W et al. Human infection with a novel avian-origin influenza a (h7n9) virus. N Engl J Med 2013; 368: 1888–97.
- 2Chen Y, Liang W, Yang S, Wu N, Gao H, Sheng J et al. Human infections with the emerging avian influenza a h7n9 virus from wet market poultry: clinical analysis and characterisation of viral genome. Lancet 2013; 381: 1916–25.
- 3Gao HN, Lu HZ, Cao B, Du B, Shang H, Gan JH et al. Clinical findings in 111 cases of influenza a (h7n9) virus infection. N Engl J Med 2013; 368: 2277–85.
- 4Mamas MA, Fraser D, Neyses L. Cardiovascular manifestations associated with influenza virus infection. Int J Cardiol 2008; 130: 304–9.
- 5Warren-Gash C, Smeeth L, Hayward AC. Influenza as a trigger for acute myocardial infarction or death from cardiovascular disease: a systematic review. Lancet Infect Dis 2009; 9: 601–10.
- 6Kumar K, Guirgis M, Zieroth S, Lo E, Menkis AH, Arora RC et al. Influenza myocarditis and myositis: case presentation and review of the literature. Can J Cardiol 2011; 27: 514–22.
- 7Chacko B, Peter JV, Pichamuthu K, Ramakrishna K, Moorthy M, Karthik R et al. Cardiac manifestations in patients with pandemic (h1n1) 2009 virus infection needing intensive care. J Crit Care 2012; 27: 106, e101–106.
- 8McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K et al. Esc guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the european society of cardiology. Developed in collaboration with the heart failure association (hfa) of the esc. Eur J Heart Fail 2012; 33: 1787–847.
- 9Quinones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA. Recommendations for quantification of doppler echocardiography: a report from the doppler quantification task force of the nomenclature and standards committee of the american society of echocardiography. J Am Soc Echocardiogr 2002; 15: 167–84.
- 10Yingchoncharoen T, Agarwal S, Popovic ZB, Marwick TH. Normal ranges of left ventricular strain: a meta-analysis. J Am Soc Echocardiogr 2013; 26: 185–91.
- 11Ternacle J, Berry M, Cognet T, Kloeckner M, Damy T, Monin JL et al. Prognostic value of right ventricular two-dimensional global strain in patients referred for cardiac surgery. J Am Soc Echocardiogr 2013; 26: 721–6.
- 12Madjid M, Naghavi M, Litovsky S, Casscells SW. Influenza and cardiovascular disease: a new opportunity for prevention and the need for further studies. Circulation 2003; 108: 2730–6.
- 13Martin SS, Hollingsworth CL, Norfolk SG, Wolfe CR, Hollingsworth JW. Reversible cardiac dysfunction associated with pandemic 2009 influenza a(h1n1). Chest 2010; 137: 1195–7.
- 14Zanotti-Cavazzoni SL, Hollenberg SM. Cardiac dysfunction in severe sepsis and septic shock. Curr Opin Crit Care 2009; 15: 392–7.
- 15Al-Amoodi M, Rao K, Rao S, Brewer JH, Magalski A, Chhatriwalla AK. Fulminant myocarditis due to h1n1 influenza. Circ Heart Fail 2010; 3: e7–9.
- 16Bratincsak A, El-Said HG, Bradley JS, Shayan K, Grossfeld PD, Cannavino CR. Fulminant myocarditis associated with pandemic h1n1 influenza a virus in children. J Am Coll Cardiol 2010; 55: 928–9.
- 17Komai T, Nakazawa G, Asai S, Ikari Y. Fatal Fulminant myocarditis associated with novel influenza a (h1n1) infection. Eur Heart J 2011; 32: 283.
- 18Khouzam RN, Parizianu C, Hafiz AM, Chawla S, Schwartz R. Fulminant myocarditis associated with novel h1n1 influenza a. Heart Lung 2011; 40: 566–8.
- 19Ukimura A, Izumi T, Matsumori A. A national survey on myocarditis associated with the 2009 influenza a (h1n1) pandemic in japan. Circ J 2010; 74: 2193–9.
- 20Mavrogeni S, Bratis C, Kitsiou A, Kolovou G, Manoussakis MN, Papadopoulou E et al. Cmr assessment of myocarditis in patients with cardiac symptoms during h1n1 viral infection. JACC Cardiovasc Imaging 2011; 4: 307–9.
- 21Ison MG, Campbell V, Rembold C, Dent J, Hayden FG. Cardiac findings during uncomplicated acute influenza in ambulatory adults. Clin Infect Dis 2005; 40: 415–22.
- 22Greaves K, Oxford JS, Price CP, Clarke GH, Crake T. The prevalence of myocarditis and skeletal muscle injury during acute viral infection in adults: measurement of cardiac troponins i and t in 152 patients with acute influenza infection. Arch Intern Med 2003; 163: 165–8.