Heart Condition in Convalescents of Hemorrhagic Fever with Renal Syndrome According to Echocardiography Data

Aim. To study the morpho-functional parameters of the heart in convalescents of hemorrhagic fever with renal syndrome (HFRS) using echocardiography.

Material and methods. The study included 27 patients without any chronic diseases who had severe or moderate HFRS (the main group) within 3 weeks after their discharge from the infection diseases hospital. The reference group consisted of 19 patients comparable by age and gender, without any chronic diseases. Transthoracic echocardiography was the basic method of heart and hemodynamics investigation. The test was performed using tissue Doppler and non-Doppler assessment of left ventricle systolic deformation method (speckle-tracking method).

Results. Violation of longitudinal systolic deformation of the left ventricle was observed in 15 (55.6%) patients, which was combined with diastolic left ventricle filling by the type of relaxation violation in 8 (29.6%) cases. Mitral valve insufficiency of 1 degree was identified in 11 (40.7%) HFRS patients, insufficiency of the tricuspid valve of 1 degree was identified in 4 (14.8%) patients. Pericardial effusion was detected in 2 (7.4%) patients. In 7 (25.9%) patients in the first 3 weeks after discharge from the hospital, additional floating echoes were detected on the leaves and fibrous ring of the aortic valve, which were considered as a manifestation of thromboendocarditis.

Conclusion. Further investigation is necessary to assess the prognostic value (including the risk of thromboembolic complication developing) of the changes revealed in HFRS convalescents and to support the inclusion of echocardiography in the examination program during dispensary observation of HFRS-convalescents.

1. Muhetdinova GA, Fazlyeva RM, Ibragimova LA, et al. Cardiovascular characteristics of pa-tients with hemorrhagic fever with renal syndrome. Infekc. bolezni (Infectious diseases) 2018;16(4):48–54 (In Russ.) DOI:10.20953/1729-9225-2018-4-48-54.

2. Rasmuson J, Lindqvist P, Sorenson K, Hedstrom M. Cardiopulmonary involvement in Pu-umala hantavirus infection. BMC Infectious Diseases. 2013;13:501. DOI:10.1186/1471-2334-13-501.

3. Makela S, Kokkonen L, Ala-Houhala I, et al. More than half of the patients with acute Puuma-la hantavirus infection have abnormal cardiac findings. Scand J Infect Dis. 2009;41(1):57-62. DOI:10.1080/00365540802502629.

4. Muhetdinova GA, Fazlyeva RM, Makeva GK, et al. Study of the role of brain natriuretic pro-peptide in hemorrhagic fever with renal syndrome. Bulletin of the Bashkir State Medical University. 2013;4:58-64 (In Russ.)

5. Galieva GA, Fazlyeva RM, Mirsaeva GKh, et al. Clinical and morphological parallels of internal organ damage in hemorrhagic fever with renal syndrome. Medical Bulletin of Bashkortostan. 2019;14(6):13-8 (In Russ.)

6. Ibragimova LA, Fazlyeva RM, Mirsaeva GH. Comparative evaluation of Central hemodynam-ic parameters and the relationship of hemodynamic changes with vegetative regulation in patients with hemorrhagic fever with renal syndrome. Medical Bulletin of Bashkortostan. 2008;3(2):50-4 (In Russ.)

7. Connolly-Andersen AM, Hammargren E, Whitaker H, et al. Increased Risk of Acute Myocardial Infarction and Stroke During Hemorrhagic Fever with Renal Syndrome. Circulation. 2014;129(12):1295-302. DOI:10.1161/circulationaha.113.001870.

8. Martynenko AYu, Tomilka GS, Obukhova GG. Dynamics of cytokines in hemorrhagic fever with renal syndrome. Far Eastern Medical Journal. 2015;4:47-50 (In Russ.)

9. Murzabaeva RT, Valishin DA, Kutluguzhina FG. The relationship between the hemostatic system and proinflammatory cytokines in hemorrhagic fever with renal syndrome. International Academic Bulletin. 2016;2(14):12-6 (In Russ.)

10. Baigildina A.A. Indicators of vascular function in hemorrhagic fever with renal syndrome. Morphological Statements. 2008;3-4:155-8 (In Russ.)

11. Oleynikov VE, Galimskaya VA, Kupriyanova SN, Burko NV. Use of the Speckle tracking method for determining global parameters of heart contractility in healthy individuals. MethodsX. 2018;5:125–35. DOI:10.1016/j.mex.2018.01.011.

12. Nikiforov VS, Nikishhenkova JuV. Modern features of speckle-tracking echocardiography in clinical practice. Rational Pharmacotherapy in Cardiology. 2017;13(2):248-55 (In Russ.) DOI:10.20996/1819-6446-2017-13-2-248-255.

13. Valishin DA, Murzabaeva RT, Galimov RR, Shestakov IV. Hemorrhagic fever with renal syndrome in adults. Clinical practice guidelines 2014 [cited by Feb 10, 2020]. Available from: http://nnoi.ru/uploads/files/protokoly/GLPS.pdf (In Russ.)

14. Naguch SF, Smiseth OA, Appleton CP, Byrd BF. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. ASE/EACVI guidelines and standards. Journal of the American Society of Echocardiography. 2016; 29(4):277-314. DOI:10.1016/j.echo.2016.01.011.

15. Nagueh SF, Middleton KJ, Kopelen HA. Doppler tissue Imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol. 1997;30:1527–33. DOI:10.1016/s0735-1097(97)00344-6.

16. Nageh H, Kopelen HA, Zoghbi WA. Estimation of mean right atrial pressure using tissue doppler imaging. Am J Cardiol. 1999;12:203-8. DOI:10.1016/s0002-9149(99)00595-0.

17. Lesson P, Augustine P, Mitchell ARJ, Becher H. Left ventricular strain. In: Lesson P, Augustine P, Mitchell ARJ, Becher H, eds. Oxford specialist handbooks in cardiology. Echocardiography. Second edition. Oxford; Oxford university press: 2012. pp. 238-245.

18. Alekhin MN. Tissue Doppler of the fibrous rings of the atrioventricular valves. In: Alekhin MN, ed. Tissue Doppler in clinical echocardiography. Moscow: Insvyazizdat; 2006. pp. 24-40. Russian

19. Tkachenko S.B., Beresten N.F. Theory of the spiral structure of the ventricles of the heart. In: Tkachenko S.B., Beresten N.F., eds. Tissue Doppler investigation of the myocardium M.: Real time; 2006. pp. 2-19. (In Russ.)

20. Atkov OYu. Evaluation of systolic and diastolic function of the ventricles of the heart. In: Atkov O. Yu., ed. Ultrasound examination of the heart and blood vessels. 2nd edition, expanded and expanded. Moscow: Eksmo. 2015 (In Russ.)

21. Caforio ALP, Pankuweit S, Arbustini E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. European Heart Journal. 2013;34:2636–48. DOI:10.1093/eurheartj/eht210.

22. Diagnosis and treatment of myocarditides. Clinical guidelines of EAC. Eurasian Heart Journal. 2019;3:20-33 (In Russ.)

23. Krumm P, Zitzelsberger T, Gawaz M, Greulich S. Young patient with hantavirus-induced myocarditis detected by comprehensive cardiac magnetic resonance assessment. BMC Infectious Diseases. 2019;19(1):15. DOI:10.1186/s12879-018-3658-8.

24. Davydova NV, Aleskerov JeJe, Rogozhkina JuA, Zhmurov VA. A clinical case of the development of combined pathology in a patient after suffering from hemorrhagic fever with renal syn-drome. University medicine of the Urals. 2019;5(1):72-4 (In Russ.)