Cardiovascular changes in patients with non-severe Plasmodium vivax malaria

• Type of Material: Article
• Authors: Aristoteles Comte Alencar-Filho, Amazonas Federal University; Joao Marcos Bemfica Barbosa Ferreira, Amazonas State University; Jorge Salinas, Emory University; Camila Fabbri, North University Center; Wuelton Marcelo Monteiro, Amazonas State University; Andre Machado Siqueira, Fundacao Oswaldo Cruz; Katashi Okoshi, Botucatu Medical School; Marcus Vinicius Guimaraes Lacerda, Amazonas State University; Marina Politi Okoshi, Botucatu Medical School
• Language: English
• Date: 2016-06-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: Copyright © 2016 The Authors
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ijcha.2016.03.004
• Title of Journal or Parent Work: International Journal of Cardiology: Heart and Vasculature
• ISSN: 2352-9067
• Volume: 11
• Start Page: 12
• End Page: 16
• Grant/Funding Information: Financial support was provided by CNPq (306857/2012-0, 306845/2012-1, and 479085/2013-7).
• Keywords: Myocardial injury; Ventricular function; Right ventricle; Pulmonary artery pressure; Prognosis; Echocardiogram
• Research Categories: Health Sciences, Medicine and Surgery; Biology, General

Abstract

Background: Cardiovascular system involvement in patients with Plasmodium vivax malaria has been poorly addressed. The aim of this study was to evaluate cardiac structures and function, and serum markers of cardiovascular injury in patients with the non-severe form of vivax malaria in Manaus, Amazonas State, Brazil. Methods and results: We prospectively evaluated 26 patients with vivax malaria in an outpatient referral hospital and compared results with a control group of 25 gender- and age-matched healthy individuals. Patients underwent clinical evaluation, laboratory tests, and transthoracic echocardiography at first evaluation (day zero, D0) and seven days (D7) after malaria diagnosis. At D0 echocardiography showed higher left ventricular (LV) systolic diameter (28.8 ± 2.82 vs 30.9 ± 4.03 mm; p = 0.037) and LV diastolic volume (82.4 ± 12.3 vs 93.8 ± 25.9 ml; p = 0.05), and lower LV ejection fraction (Teicholz method: 73.2 ± 6.59 vs 68.4 ± 4.87%; p = 0.004) in patients compared to controls. Right ventricle (RV) fractional area change (54.7 ± 5.11 vs 50.5 ± 6.71%; p = 0.014) was lower, and RV myocardial performance index (0.21 ± 0.07 vs 0.33 ± 0.19; p = 0.007), and pulmonary vascular resistance (1.13 ± 0.25 vs 1.32 ± 0.26 Woods unit; p = 0.012) were higher in patients than controls. Patients presented higher serum levels of unconjugated bilirubin (0.24 ± 0.15 vs 1.30 ± 0.89 mg/dL; p < 0.001), soluble vascular cell adhesion molecule-1 (sVCAM-1; 453 ± 143 vs 1983 ± 880 ng/mL; p < 0.001), N-terminal prohormone brain natriuretic peptide (0.59 ± 0.86 vs 1.08 ± 0.81 pg/mL; p = 0.045), and troponin T (861 ± 338 vs 1037 ± 264 pg/mL; p = 0.045), and lower levels of plasma nitrite (13.42 ± 8.15 vs 8.98 ± 3.97 μM; p = 0.016) than controls. Most alterations had reversed by D7. Conclusion: Patients with non-severe Plasmodium vivax malaria present subclinical reversible cardiovascular changes.