Unadjusted associations between self-reported clinical DENV infection and echocardiographic parameters by linear regression models.

Unadjusted associations between self-reported clinical DENV infection and echocardiographic parameters by linear regression models.</p

Variance inflation factor of sociodemographic factors.

(DOCX)</p

Cardiovascular symptoms stratified by altered LVEF and/or GLS.

Cardiovascular symptoms stratified by altered LVEF and/or GLS.</p

S1 File -

(XML)</p

Association between sociodemographic variables and previous DENV infection.

Association between sociodemographic variables and previous DENV infection.</p

Baseline characteristics of men stratified by history of clinical DENV infection.

Baseline characteristics of men stratified by history of clinical DENV infection.</p

Proposed mechanisms of cardiac injury in dengue.

Potential mechanisms for dengue induced myocardial impairment: (1) Direct infection of cardiomyocytes causing apoptosis and inflammation. (2) Vascular leakage induced by NS1, which leads to intravascular volume depletion and reduced preload, eventually causing cardiac ischemia. NS1 has also been associated with endothelial dysfunction and altered coronary microcirculation. (3) Inflammation in the cardiac vasculature and myocardial interstitial edema driven by an imbalanced immune response with release of pro-inflammatory cytokines. Over time the proposed mechanisms may lead to myocardial fibrosis and impaired contractility.</p

Association between number of dengue episodes and LV systolic function.

(DOCX)</p

Cardiac involvement in other tropical infections.

Cardiac involvement in other tropical infections.</p

Supplemental methods.

(DOCX)</p