Electrocardiographic changes and troponin T levels in children with severe malaria anemia and heart failure

Abstract

Background: Severe malaria anemia is a major cause of childhood heart failure in malaria endemic countries. The resulting hypoxic‑ischemic injuries may cause myocardial damage detectable by electrocardiogram (ECG) and elevated troponin T (cTnT) levels.

Objective: Evaluate the ECG changes and cTnT levels in children with severe malaria anemia compared with those who had uncomplicated malaria without anemia.

Methods: Consecutive children with severe malaria anemia were recruited as subjects while controls were age‑ and gender‑matched children with uncomplicated malaria without anemia. ECG findings, cTnT levels, and the proportion of children with elevated cTnT were compared between subjects and controls.

Results: There were 43 subjects with a mean age of 25.7 ± 22.9 months. Controls were forty children; mean age was 31.2 ± 20.0 months. All the subjects and 10 (25.0%) controls had ECG abnormalities. Five (11.6%) subjects and no control had ST segment changes, P = 0.06. Twenty‑three percent of subjects compared to 5% of the controls had prolonged QTc, P = 0.027. Median cTnT of subjects (131.8 ng/L) was not significantly higher than the 85.9 ng/L of controls, P = 0.99. The median cTnT of subjects that died 208.9 ng/L was higher than in survivors 99.6 ng/L, P = 0.51.

Conclusion: Prolonged QTc was more prevalent in children with severe malaria anemia compared to those without anemia, suggesting that children with severe malaria anemia were more prone to arrhythmias. The median cTnT value in the subjects was not significantly lower than that in controls, suggesting that children with severe malaria anemia are not prone to myocardial injury any more than those with uncomplicated malaria without anemia.

Keywords: Anemia, electrocardiogram, heart failure, malaria, myocardial injury, troponin T