Reduced Cardiac Index Reserve and Hypovolemia in Severe Falciparum Malaria

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

doi:10.1093/infdis/jiz568

Reduced Cardiac Index Reserve and Hypovolemia in Severe Falciparum Malaria

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

Global and Tropical Health

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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.

Original language	English
Pages (from-to)	1518-1527
Number of pages	10
Journal	Journal of Infectious Diseases
Volume	221
Issue number	9
DOIs	https://doi.org/10.1093/infdis/jiz568
Publication status	Published - 1 May 2020

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Kingston, H. W. F., Ghose, A., Rungpradubvong, V., Satitthummanid, S., Herdman, M. T., Plewes, K., Leopold, S. J., Ishioka, H., Mohanty, S., Maude, R. J., Schultz, M. J., Lagrand, W. K., Hossain, M. A., Day, N. P. J., White, N. J., Anstey, N. M., & Dondorp, A. M. (2020). Reduced Cardiac Index Reserve and Hypovolemia in Severe Falciparum Malaria. Journal of Infectious Diseases, 221(9), 1518-1527. https://doi.org/10.1093/infdis/jiz568

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title = "Reduced Cardiac Index Reserve and Hypovolemia in Severe Falciparum Malaria",

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.",

keywords = "Echocardiography, Hemodynamics, Hypovolemia, Severe malaria, Systolic function",

author = "Kingston, {Hugh W.F.} and Aniruddha Ghose and Voravut Rungpradubvong and Sudarat Satitthummanid and Herdman, {M. Trent} and Katherine Plewes and Leopold, {Stije J.} and Haruhiko Ishioka and Sanjib Mohanty and Maude, {Richard J.} and Schultz, {Marcus J.} and Lagrand, {Wim K.} and Hossain, {Md Amir} and Day, {Nicholas P.J.} and White, {Nicholas J.} and Anstey, {Nicholas M.} and Dondorp, {Arjen M.}",

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Kingston, HWF, Ghose, A, Rungpradubvong, V, Satitthummanid, S, Herdman, MT, Plewes, K, Leopold, SJ, Ishioka, H, Mohanty, S, Maude, RJ, Schultz, MJ, Lagrand, WK, Hossain, MA, Day, NPJ, White, NJ, Anstey, NM & Dondorp, AM 2020, 'Reduced Cardiac Index Reserve and Hypovolemia in Severe Falciparum Malaria', Journal of Infectious Diseases, vol. 221, no. 9, pp. 1518-1527. https://doi.org/10.1093/infdis/jiz568

TY - JOUR

T1 - Reduced Cardiac Index Reserve and Hypovolemia in Severe Falciparum Malaria

AU - Kingston, Hugh W.F.

AU - Ghose, Aniruddha

AU - Rungpradubvong, Voravut

AU - Satitthummanid, Sudarat

AU - Herdman, M. Trent

AU - Plewes, Katherine

AU - Leopold, Stije J.

AU - Ishioka, Haruhiko

AU - Mohanty, Sanjib

AU - Maude, Richard J.

AU - Schultz, Marcus J.

AU - Lagrand, Wim K.

AU - Hossain, Md Amir

AU - Day, Nicholas P.J.

AU - White, Nicholas J.

AU - Anstey, Nicholas M.

AU - Dondorp, Arjen M.

PY - 2020/5/1

Y1 - 2020/5/1

N2 - 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.

AB - 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.

KW - Echocardiography

KW - Hemodynamics

KW - Hypovolemia

KW - Severe malaria

KW - Systolic function

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U2 - 10.1093/infdis/jiz568

DO - 10.1093/infdis/jiz568

M3 - Article

C2 - 31693130

AN - SCOPUS:85083888281

SN - 0022-1899

VL - 221

SP - 1518

EP - 1527

JO - Journal of Infectious Diseases

JF - Journal of Infectious Diseases

IS - 9

ER -

Reduced Cardiac Index Reserve and Hypovolemia in Severe Falciparum Malaria

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