Chest
Volume 137, Issue 5, May 2010, Pages 1195-1197
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SELECTED REPORTS
Reversible Cardiac Dysfunction Associated With Pandemic 2009 Influenza A(H1N1)

https://doi.org/10.1378/chest.10-0032Get rights and content

Historical influenza A epidemics have carried elevated rates of cardiovascular disease, including transient cardiac dysfunction. Whether such an association holds for the novel influenza A strain, pandemic 2009 influenza A(H1N1) [A(H1N1)], remains unknown. We report an index case of transient cardiac dysfunction associated with A(H1N1) infection. Next, we reviewed 123 sequential cases of patients hospitalized with pandemic A(H1N1) at a single academic medical center in the United States from April 1, 2009, through October 31, 2009. We identified that 4.9% (6/123) of patients had either new or worsened left ventricular dysfunction. These cases ranged in age from 23 to 51 years, and all had preexisting medical conditions. ICU level care was required in 83% (5/6) of the cases. Sixty-seven percent (4/6) of the cases had follow-up echocardiograms, and left ventricular function improved in all four. We conclude that potentially reversible cardiac dysfunction is a relatively common complication associated with hospitalized pandemic A(H1N1) influenza.

Section snippets

Materials and Methods

We retrospectively reviewed medical charts of all pediatric and adult patients sequentially hospitalized at Duke University Medical Center with pandemic A(H1N1) from April 1, 2009, to October 31, 2009. Our case definition required hospitalization for at least 24 h because of an influenza-like illness (fever plus cough or sore throat) with pandemic A(H1N1) infection confirmed by RT-PCR or viral culture. All testing used standard Centers for Disease Control and Prevention-based primers. Because >

Results

In our series of 123 patients, 24 (19.5%) had at least one echocardiogram during their hospitalization, and six (4.9%) had new (cases 1–3, 5, 6) or worsened (case 4) left ventricular dysfunction during their hospitalization, as summarized in Table 1. The age range was 23 to 51 years. All had preexisting medical conditions, five required hospitalization > 3 weeks with prolonged ICU care, and two died. All four in whom follow-up echocardiograms were obtained, at a range of 4 to 22 days into

Discussion

Historically, influenza has been linked to cardiovascular disease. Epidemiologic analyses have illustrated an increase in cardiovascular deaths during influenza epidemics.1 Although the mechanism of increased cardiovascular deaths remains unknown, previous reports suggest the possibility of influenza myocarditis, exacerbation of pre-existing coronary disease, or worsening of congestive heart failure.2 A recent systematic review of 39 studies found diverse but consistent observational evidence

Acknowledgments

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Other contributions: This work was performed at the Duke University Medical Center.

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Funding/Support: This work was supported by the National Institutes of Health [Grants ES16126, ES16659, AI81672].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).

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