Assessment of myocardial function and injury by echocardiography and cardiac biomarkers in African children with severe plasmodium falciparum malaria

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dc.contributor.author Kotlyar, Simon
dc.contributor.author Olupot-Olupot, Peter
dc.contributor.author Nteziyaremye, Julius
dc.contributor.author Akech, Samuel
dc.contributor.author Uyoga, Sophie
dc.contributor.author Muhindo, Rita
dc.contributor.author Moore, Christopher L.
dc.contributor.author Maitland, Kathryn
dc.date.accessioned 2018-12-17T15:19:43Z
dc.date.available 2018-12-17T15:19:43Z
dc.date.issued 2017
dc.identifier.issn 1947-3893
dc.identifier.uri http://hdl.handle.net/20.500.12283/153
dc.description.abstract Objectives: Perturbed hemodynamic function complicates severe malaria. The Fluid Expansion as Supportive Therapy trial demonstrated that fluid resuscitation, involving children with severe malaria, was associated with increased mortality, primarily due to cardiovascular collapse, suggesting that myocardial dysfunction may have a role. The aim of this study was to characterize cardiac function in children with severe malaria. Design: A prospective observational study with clinical, laboratory, and echocardiographic data collected at presentation (T0) and 24 hours (T1) in children with severe malaria. Cardiac index and ejection fraction were calculated at T0 and T1. Cardiac troponin I and brain natriuretic peptide were measured at T0. We compared clinical and echocardiographic variables in children with and without severe malarial anemia (hemoglobin < 5 mg/dL) at T0 and T1. Setting: Mbale Regional Referral Hospital. Patients: Children 3 months to 12 years old with severe falciparum malaria. Interventions: Usual care. Measurements and Main Results: We enrolled 104 children, median age 23.3 months, including 61 children with severe malarial anemia. Cardiac troponin I levels were elevated (> 0.1 ng/mL) in n equals to 50, (48%), and median brain natriuretic peptide was within normal range (69.1 pg/mL; interquartile range, 48.4–90.8). At T0, median Cardiac index was significantly higher in the severe malarial anemia versus nonsevere malarial anemia group (6.89 vs 5.28 L/min/m2) (p = 0.001), which normalized in both groups at T1 (5.60 vs 5.13 L/min/m2) (p = 0.452). Cardiac index negatively correlated with hemoglobin, r equals to –0.380 (p < 0.001). Four patients (3.8%) had evidence of depressed cardiac systolic function (ejection fraction < 45%). Overall, six children died, none developed pulmonary edema, biventricular failure, or required diuretic treatment. Conclusions: Elevation of cardiac index, due to increased stroke volume, in severe malaria is a physiologic response to circulatory compromise and correlates with anemia. Following whole blood transfusion and antimalarial therapy, cardiac index in severe malarial anemia returns to normal. The majority (> 96%) of children with severe malaria have preserved myocardial systolic function. Although there is evidence for myocardial injury (elevated cardiac troponin I), this does not correlate with cardiac dysfunction. en_US
dc.description.sponsorship Philips Medical Mbale Regional Referral Hospital en_US
dc.language.iso en en_US
dc.publisher Lippincott, Williams & Wilkins en_US
dc.subject Cardiac en_US
dc.subject Echocardiography en_US
dc.subject Falciparum en_US
dc.subject Malaria en_US
dc.subject Pediatric en_US
dc.title Assessment of myocardial function and injury by echocardiography and cardiac biomarkers in African children with severe plasmodium falciparum malaria en_US
dc.type Article en_US


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