Electrocardiographic Evaluation of Patients with Crimean-Congo Hemorrhagic Fever

Abstract

Infectious diseases can affect the myocardium directly or through cytokines. Disruption of cardiac depolarization and repolarization is associated with the development of arrhythmia. In this study, we aimed to evaluate electrocardiographic (ECG) parameters in patients with Crimean-Congo Hemorrhagic Fever (CCHF). 42 patients hospitalized with the diagnosis of CCHF were included in the study. Heart rate, PR interval, P dispersion, QRS duration, QT interval and corrected QT, T peak T end, Tp-e/QT ratio, Tp-e/QTc ratio, and QT dispersion parameters were calculated from 12-lead ECGs at the time of admission and discharge. The mean age of the patients in the study was 45.8 ± 16.9 years. ECG parameters were found to be similar at admission and discharge (all p values>0.1). Major events such as life-threatening bleeding, significant hypotension, and shock were not observed in any of the patients. Platelet and white blood cell values were significantly increased at discharge compared to admission (78.3 vs 197.6 x103, p=0.01 and 2.8 vs 5.4 x103, p=0.006 respectively). In patients with CCHF, there was no significant change in ECG polarization parameters at the onset of the active infection process and during hospitalization period and these parameters found to be within normal limits.

Keywords

• Crimean-Congo Hemorrhagic Fever
• electrocardiography
• Tp-e
• Tp-e/QT
• P dispersion

References

1. 1. Whitehouse CA. Crimean-Congo hemorrhagic fever. Antiviral Res. 2004; 64(3):145-60.
2. 2. Ergonul O. Crimean-Congo haemorrhagic fever. Lancet Infect Dis. 2006; 6(4):203-14.
3. 3. Engin A, Yilmaz MB, Elaldi N, et al. Crimean-Congo hemorrhagic fever: does it involve the heart? Int J Infect Dis. 2009; 13(3):369-73.
4. 4. Rose NR. Critical cytokine pathways to cardiac inflammation. J Interferon Cytokine Res. 2011; 31(10):705-10.
5. 5. Babapoor-Farrokhran S, Gill D, Walker J, Rasekhi RT, Bozorgnia B, Amanullah A. Myocardial injury and COVID-19: Possible mechanisms. Life Sci. 2020; 253:117723.
6. 6. Antzelevitch C, Di Diego JM, Argenziano M. Tpeak-Tend as a predictor of ventricular arrhythmogenesis. Int J Cardiol. 2017; 249:75-76.
7. 7. Panikkath R, Reinier K, Uy-Evanado A, et al. Prolonged Tpeak-to-tend interval on the resting ECG is associated with increased risk of sudden cardiac death. Circ Arrhythm Electrophysiol. 2011; 4(4):441-47.
8. 8. Malik M, Batchvarov VN. Measurement, interpretation and clinical potential of QT dispersion. J Am Coll Cardiol. 2000; 36(6):1749-66.

9. 9. Koca H, Koç M. What is the Normal Value of Tpe Interval and Corrected Tpe Interval? Acta Medica. 2020; 51(4):10-15.
10. 10. Okutucu S, Aytemir K, Oto A. P-wave dispersion: What we know till now? JRSM Cardiovasc Dis. 2016; 5:2048004016639443.
11. 11. Tatlisu MA, Ozcan KS, Gungor B, et al. Can the T-peak to T-end interval be a predictor of mortality in patients with ST-elevation myocardial infarction? Coron Artery Dis. 2014; 25(5):399-404.
12. 12. Antzelevitch C, Sicouri S, Di Diego JM, et al. Does Tpeak-Tend provide an index of transmural dispersion of repolarization? Heart Rhythm. 2007;4(8):1114-6; author reply 1116-19.
13. 13. Yilmaz MB, Engin A, Bektasoglu G, et al. Does electrocardiography at admission predict outcome in Crimean -Congo hemorrhagic fever? J Vector Borne Dis. Sep 2011;48(3):150-54.
14. 14. Yajima T. Viral myocarditis: potential defense mechanisms within the cardiomyocyte against virus infection. Future Microbiol. 2011; 6(5):551-66.
15. 15. Rose NR. Viral myocarditis. Curr Opin Rheumatol. 2016; 28(4):383-89.
16. 16. Ergonul O, Tuncbilek S, Baykam N, Celikbas A, Dokuzoguz B. Evaluation of serum levels of interleukin (IL)-6, IL-10, and tumor necrosis factor-alpha in patients with Crimean-Congo hemorrhagic fever. J Infect Dis. 2006; 193(7):941-44.
17. 17. Swanepoel R, Gill DE, Shepherd AJ, Leman PA, Mynhardt JH, Harvey S. The clinical pathology of Crimean-Congo hemorrhagic fever. Rev Infect Dis. 1989; 11 Suppl 4:S794-800.
18. 18. Erol S, Özkurt Z, Özden K, Parlak M, Erol MKJTJoMS. Transient bradycardia in patients with Crimean-Congo hemorrhagic fever. Turk J Med Sci. 2012; 42(5):753-56.
19. 19. Cummins D, Bennett D, Fisher-Hoch SP, Farrar B, McCormick JB. Electrocardiographic abnormalities in patients with Lassa fever. J Trop Med Hyg. 1989; 92(5):350-55.
20. 20. Mahmod M, Darul ND, Mokhtar I, Nor NM, Anshar FM, Maskon O. Atrial fibrillation as a complication of dengue hemorrhagic fever: non-self-limiting manifestation. Int J Infect Dis. 2009; 13(5):e316-18.
21. 21. Basin B, Piperaud R, Guilbaud JC, Moussinga N. [Atrioventricular block in 2 patients with hemorrhagic fever and renal syndrome (Hantaan-virus nephropathy)]. Rev Med Interne. 1992; 13(3):244-45.
22. 22. Park CW, Kim SY, Choi EJ, Chang YS, Bang BK. Transient disappearance of hyperthyroidism with atrial fibrillation during the course of acute renal failure caused by haemorrhagic fever with renal syndrome. Nephrol Dial Transplant. 1996; 11(4):702-703.
23. Kapetanovic B, Ridanovic Z, Petrovic O, Arslanagic A. [ECG in patients with hemorrhagic fever]. Med Arh. 1992; 46(3-4):63-65.