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Meta-Analysis
. 2022 Sep 8;14(9):1988.
doi: 10.3390/v14091988.

Heart Disease and Arboviruses: A Systematic Review and Meta-Analysis

Jandir Mendonça Nicacio  1   2 , Orlando Vieira Gomes  1   2 , Rodrigo Feliciano do Carmo  3   4 , Sávio Luiz Pereira Nunes  4 , José Roberto Coelho Ferreira Rocha  1 , Carlos Dornels Freire de Souza  1   2 , Rafael Freitas de Oliveira Franca  5 , Ricardo Khouri  6   7   8 , Manoel Barral-Netto  6   7   9 , Anderson da Costa Armstrong  1   2
Affiliations
Meta-Analysis

Heart Disease and Arboviruses: A Systematic Review and Meta-Analysis

Jandir Mendonça Nicacio et al. Viruses. .

Abstract

Dengue fever, chikungunya, and zika are highly prevalent arboviruses transmitted by hematophagous arthropods, with a widely neglected impact in developing countries. These diseases cause acute illness in diverse populations, as well as potential cardiovascular complications. A systematic review was carried out to investigate the burden of cardiac involvement related to these arboviruses. Multiple databases were searched for articles that investigated the association of cardiovascular diseases with arboviruses, published up to March 2022. Relevant articles were selected and rated by two independent reviewers. Proportion meta-analysis was applied to assess the frequency-weighted mean of the cardiovascular findings. A total of 42 articles were selected (n = 76,678 individuals), with 17 manuscripts on dengue and 6 manuscripts on chikungunya undergoing meta-analysis. The global pooled incidence of cardiac events in dengue fever using a meta-analysis was 27.21% (95% CI 20.21-34.83; I2 = 94%). The higher incidence of dengue-related myocarditis was found in the population younger than 20 years old (33.85%; 95% CI 0.00-89.20; I2 = 99%). Considering the studies on chikungunya (n = 372), the global pooled incidence of cardiac involvement using a meta-analysis was 32.81% (95% CI 09.58-61.49, I2 = 96%). Two Zika studies were included that examined cases of infection by vertical transmission in Brazil, finding everything from structural changes to changes in heart rate variability that increase the risk of sudden death. In conclusion, cardiac involvement in arboviruses is not uncommon, especially in dengue fever.

Keywords: arboviruses; cardiac involvement; chikungunya; dengue; zika.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of study selection for inclusion in the literature review.
Figure 2
Figure 2
Forest plot comparison of the frequency of cardiac events in patients with chikungunya. Legend: CI—confidence interval.
Figure 3
Figure 3
Forest plot comparison of the frequency of cardiac events in patients with dengue, grouped by age group. Legend: CI—confidence interval.
Figure 4
Figure 4
Forest plot comparison of the frequency of cardiac events in patients with dengue, grouped by continent. Legend: CI—confidence interval.
Figure 5
Figure 5
Forest plot of the frequency of cardiac events in dengue, using ESC criteria, 2013. Legend: CI—confidence interval; ESC—European Society of Cardiology.
Figure 6
Figure 6
Scatter plot showing the frequency of cardiac events in patients with dengue through meta-regression.
See this image and copyright information in PMC

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