Assessment of cardiac function in children with tuberculosis

Introduction: Tuberculosis (TB) continues to be a major global health concern, emerging evidence suggests that both pulmonary and extrapulmonary TB can cause subclinical or overt cardiac dysfunction, particularly in children. Echocardiography is a sensitive tool for early detection of myocardial, pericardial, and functional abnormalities. Early recognition of cardiac involvement and its reversibility with anti-tubercular therapy (ATT) may significantly influence clinical outcomes in paediatric population. Methods: This observational study included 50 children diagnosed with pulmonary or extrapulmonary TB. Detailed clinical evaluation, laboratory investigations (including Troponin I and Pro-BNP), and baseline echocardiographic assessment were performed using M-mode, pulsed and tissue Doppler and 2-D speckle tracking imaging. Repeat echocardiography was done after completion of ATT to assess improvement in cardiac parameters. Results: Of the 50 enrolled children, 16 (32%) demonstrated cardiac dysfunction on initial echocardiography. The most common abnormalities included impaired diastolic parameters on Doppler imaging and reduced global longitudinal strain (GLS). Elevated cardiac biomarkers was also associated with diastolic dysfunction. Post-ATT follow-up was available for 47 children. Among the 14 who initially had cardiac dysfunction, 12 (85.7%) showed significant improvement after treatment, while 2 had persistent dysfunction. No new dysfunction developed in children with normal baseline echocardiography. Conclusions: A considerable proportion of children with tuberculosis exhibit subclinical cardiac dysfunction detectable on echocardiography. Most abnormalities showed improvement following completion of ATT, underscoring the reversible nature of of TB-related cardiac involvement. Routine echocardiographic screening, should be considered in Pediatric TB to facilitate early diagnosis, timely intervention, and monitoring of treatment response.