Cardiac function in Ghanaian children with severe malaria.
OBJECTIVE
The aim was to assess whether impaired cardiac function contributes to symptoms of severe malaria in general or to metabolic acidosis in particular in children living in endemic regions.


METHODS
In a prospective observational investigation, 183 children with severe malaria were investigated for hemodynamic status and cardiac function upon admission (day 0) and after recovery (day 42). Cardiac function parameters were assessed by cardiac ultrasonography. Blood gas analyses and cardiac enzymes were measured at hospitalization and follow-up. Differences in subgroups with and without metabolic acidosis as well as other severe malaria-defining symptoms and conditions were assessed.


RESULTS
Cardiac index (CI) was significantly increased on day 0 compared to day 42 (5.8 ml/m(2), SD ± 1.8 ml/m(2), versus 4.7 ml/m(2), SD ± 1.4 ml/m(2); P < 0.001). CI correlated negatively with hemoglobin levels but not with parameters indicating impaired tissue perfusion or metabolic acidosis. Parasite levels had a significant influence on metabolic acidosis but not on CI. Alterations related to cardiac function, hemoglobin levels and metabolic acidosis were most prominent in children younger than 2 years.


CONCLUSIONS
Increased CI reflecting high output status is associated with low hemoglobin levels while metabolic acidosis is linked to parasite levels.
Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Samuel B
SB
Nguah
Torsten
T
Feldt
Steffi
S
Hoffmann
Daniel
D
Pelletier
Daniel
D
Ansong
Justice
J
Sylverken
Parisa
P
Mehrfar
Johanna
J
Herr
Christian
C
Thiel
Stephan
S
Ehrhardt
Gerd D
GD
Burchard
Jakob P
JP
Cramer
D000138:Acidosis / Q000150:complications* / Q000453:epidemiology / Q000469:parasitology; D017677:Age Distribution; D000740:Anemia / Q000453:epidemiology / Q000469:parasitology / Q000503:physiopathology; D002303:Cardiac Output, Low / Q000453:epidemiology / Q000469:parasitology*; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006334:Heart Function Tests; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000150:complications* / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D012044:Regression Analysis; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000469:parasitology*