Year: 2019
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Impaired microvascular perfusion is central to the development of coma and lactic acidosis in severe falciparum malaria. Refractory hypotension is rare on admission but develops frequently in fatal cases. We assessed cardiac function and volume status in severe falciparum malaria and its prognostic significance. METHODS: Patients with severe (N = 101) or acute uncomplicated falciparum malaria (N = 83) were recruited from 2 hospitals in India and Bangladesh, and healthy participants (N = 44) underwent echocardiography. RESULTS: Patients with severe malaria had 38% shorter left ventricular (LV) filling times and 25% shorter LV ejection times than healthy participants because of tachycardia; however, stroke volume, LV internal diameter in diastole (LVIDd), and LV internal diameter in systole (LVIDs) indices were similar. A low endocardial fraction shortening (eFS) was present in 17% (9 of 52) of severe malaria patients. Adjusting for preload and afterload, eFS was similar in health and severe malaria. Fatal cases had smaller baseline LVIDd and LVIDs indices, more collapsible inferior vena cavae (IVC), and higher heart rates than survivors. The LVIDs and IVC collapsibility were independent predictors for mortality, together with base excess and Glasgow Coma Scale. CONCLUSIONS: Patients with severe malaria have rapid ejection of a normal stroke volume. Fatal cases had features of relative hypovolemia and reduced cardiac index reserve.
Authors: Hugh W F Kingston, Aniruddha Ghose, Voravut Rungpradubvong, Sudarat Satitthummanid, M Trent Herdman, Katherine Plewes, Stije J Leopold, Haruhiko Ishioka, Sanjib Mohanty, Richard J Maude, Marcus J Schultz, Wim K Lagrand, Md Amir Hossain, Nicholas P J Day, Nicholas J White, Nicholas M Anstey, Arjen M Dondorp
Institutions: Mahidol University, Churchill Hospital, Charles Darwin University, University of Oxford, Menzies School of Health Research, Mahidol Oxford Tropical Medicine Research Unit, Chittagong Medical College, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Ispat General Hospital, Amsterdam UMC Location University of Amsterdam, University of Amsterdam
Language: English
Topic: Malaria Research and Control
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,763
Awards: Improving blood vessel function in severe malaria, G675268645, Tropical Disease - immunity, pathogenesis and vaccine development: global translation, Understanding how to develop new vaccines and drugs for tropical diseases., Pathophysiology and treatment of malaria and other tropical infectious diseases prevalent in our region
OpenAlex ID: W2982862076