Division of Cardiology, Centro Privado de Cardiología San Miguel de Tucumán, Tucumán, Argentina.
Division of Cardiology, Centro Médico Nacional Siglo XXI, Mexico, Mexico.
Cardiology. 2021;146(3):324-334. doi: 10.1159/000514206. Epub 2021 Mar 31.
Neglected tropical diseases are a group of communicable diseases that occur in tropical and subtropical conditions and are closely related to poverty and inadequate sanitation conditions. Among these entities, chikungunya remains one of the most widely spread diseases. Although the main symptoms are related to a febrile syndrome, cardiovascular (CV) involvement has been reported, with short- and long-term implications. As part of the "Neglected Tropical Diseases and other Infectious Diseases involving the Heart" (NET-Heart) Project, the aim of this review is to compile all the information available regarding CV involvement of this disease, to help healthcare providers gain knowledge in this field, and contribute to improving early diagnosis, treatment, and prevention strategies.
We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement in conducting and reporting this systematic review. The search was conducted using MEDLINE/PubMed, SciELO, and LILACS databases to identify any relevant studies or reviews detailing an association between chikungunya and cardiac involvement published from January 1972 to May 31, 2020.
Despite its mechanism not being fully understood, CV involvement has been described as the most frequent atypical presentation of chikungunya (54.2%). Myocarditis is the most prevalent CV complication. Different rhythm disturbances have been reported in 52% of cases, whereas heart failure was reported in 15% of cases, pericarditis in 5%, and acute myocardial infarction in 2%. Overall estimated CV mortality is 10%, although in patients with other comorbidities, it may increase up to 20%. In the proper clinical setting, the presence of fever, polyarthralgia, and new-onset arrhythmia suggests chikungunya virus-related myocarditis.
Although most cases are rarely fatal, CV involvement in chikungunya infection remains the most frequent atypical presentation of this disease and may have severe manifestations. Timely diagnosis and appropriate management are necessary to improve patient outcomes.
被忽视的热带病是一组发生在热带和亚热带地区的传染病，与贫困和卫生条件差密切相关。在这些实体中，基孔肯雅热仍然是传播最广泛的疾病之一。尽管主要症状与发热综合征有关，但已报道心血管（CV）受累，具有短期和长期影响。作为“被忽视的热带病和其他涉及心脏的传染病”（NET-Heart）项目的一部分，本综述的目的是汇编有关该病心血管受累的所有可用信息，帮助医疗保健提供者在这一领域获得知识，并有助于改善早期诊断、治疗和预防策略。
我们遵循系统评价和荟萃分析的首选报告项目（PRISMA）声明进行和报告这项系统综述。使用 MEDLINE/PubMed、SciELO 和 LILACS 数据库搜索任何相关研究或综述，详细描述 1972 年 1 月至 2020 年 5 月 31 日期间基孔肯雅热与心脏受累之间的关联。
尽管其机制尚未完全了解，但 CV 受累已被描述为基孔肯雅热最常见的非典型表现（54.2%）。心肌炎是最常见的 CV 并发症。报告了 52%的病例存在不同的节律障碍，15%的病例报告了心力衰竭，5%的病例报告了心包炎，2%的病例报告了急性心肌梗死。总体估计 CV 死亡率为 10%，但在有其他合并症的患者中，死亡率可能增加到 20%。在适当的临床环境中，发热、多关节炎和新发心律失常的存在提示与基孔肯雅病毒相关的心肌炎。
尽管大多数病例很少致命，但 CV 受累仍然是基孔肯雅热感染最常见的非典型表现，并且可能有严重的表现。及时诊断和适当的治疗对于改善患者的预后是必要的。
