https://doi.org/10.1177/2048872618809319 European Heart Journal: Acute Cardiovascular Care 2020, Vol. 9(8) 975–983 © The European Society of Cardiology 2018 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/2048872618809319 journals.sagepub.com/home/acc Introduction Leptospirosis is a re-emerging global zoonosis resulting in significant morbidity and mortality. While the disease has been endemic in the tropics, with outbreaks reported during heavy rains and inundations, increasing popularity of out- door water sports has resulted in sporadic outbreaks in the developed world. 1 The clinical spectrum of leptospirosis ranges from a mild febrile illness to a severe icteric disease with Cardiac involvement in critically ill patients with leptospirosis: A prospective study using myocardial deformation imaging Anoop Mathew 1,2 , Miriam Shanks 2 , Eapen Punnoose 1 , Louie Fischer 1 , George Koshy 3 , Rahul Potluri 2 and Kevin R Bainey 2 Abstract Background: Myocardial inflammation often complicates leptospirosis, a re-emerging global zoonosis. Leptospirosis associated myocardial dysfunction is equivocal and the pattern of cardiac involvement may not differ from that of sepsis associated myocarditis. Methods: We prospectively compared cardiac involvement in 113 intensive care unit patients with severe leptospirosis to 31 patients with sepsis syndrome using a comprehensive assessment comprising of clinical presentation, electrocardiography, two-dimensional echocardiography (with global longitudinal strain calculation), and cardiac biomarker evaluation. Binomial logistic regression was performed to identify independent predictors of left ventricular systolic dysfunction in leptospirosis. Results: Compared to sepsis syndrome, leptospirosis patients were younger, had higher body mass index measurements and were more likely to be smokers. Electrocardiography abnormalities were common and similar in both groups. Myocardial systolic dysfunction was common in both groups (leptospirosis: 55.86% vs sepsis syndrome: 51.61%, p=0.675) with subclinical left ventricular systolic dysfunction (characterized by abnormal global longitudinal strain and normal left ventricular ejection fraction) being most frequent followed by isolated right ventricular systolic dysfunction, isolated left ventricular systolic dysfunction, and bi-ventricular systolic dysfunction (leptospirosis: 31.43%, 18.42%, 13.16%, 10.53%, respectively; sepsis syndrome: 22.22%, 12.00%, 12.00%, 8.00%, respectively (p>0.05 for each comparator)). Leptospirosis patients had a trend towards greater troponin-T elevation (61.0% vs 40.0%, p=0.057). ST-segment elevation and elevated troponin were independent predictors of reduced left ventricular ejection fraction in leptospirosis. Conclusions: Cardiac involvement in leptospirosis appears to be similar to that of sepsis syndrome, with myocardial systolic dysfunction being common. As such, clinical vigilance pertaining to cardiac status is paramount in these high-risk patients. Keywords Leptospirosis, myocardial disease, echocardiography, myocarditis, tricuspid regurgitation, strain echocardiography Date received: 1 September 2018; accepted: 2 October 2018 1 Division of Cardiology, Malankara Orthodox Syrian Church (MOSC) Medical College Hospital, India 2 Division of Cardiology, University of Alberta, Canada 3 Department of Medicine, Malankara Orthodox Syrian Church (MOSC) Medical College Hospital, India Corresponding author: Kevin R Bainey, Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta Hospital, 11220 83 Ave NW, Edmonton, AB T6G 2B7, Canada. Email: Kevin.Bainey@albertahealthservices.ca 809319ACC European Heart Journal: Acute Cardiovascular CareMathew et al. Original scientific paper Downloaded from https://academic.oup.com/ehjacc/article/9/8/975/6125651 by guest on 07 April 2022