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Title: Reduced Cardiac Index Reserve and Hypovolemia in Severe Falciparum Malaria
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
Ispat General Hospital
Chulalongkorn University
Menzies School of Health Research
King Chulalongkorn Memorial Hospital, Faculty of Medicine Chulalongkorn University
Churchill Hospital
Mahidol University
Chittagong Medical College
Universiteit van Amsterdam
Keywords: Medicine
Issue Date: 7-Apr-2020
Citation: Journal of Infectious Diseases. Vol.221, No.9 (2020), 1518-1527
Abstract: © 2019 The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. 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.
ISSN: 15376613
Appears in Collections:Scopus 2020

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