Echocardiographic assessment of cardiac function in children with severe malaria attending two tertiary hospitals in southeast Nigeria

UNLABELLED: Cardiac dysfunction is increasingly recognized in children with severe malaria and may result from recurrent ischemia-reperfusion injury, endothelial dysfunction, and severe anaemia. However, the burden of cardiac abnormalities remains poorly characterized in many malaria-endemic countries, including Nigeria. This study evaluated cardiac function in children with severe malaria using echocardiography. A cross-sectional study involving 100 children with severe malaria and 100 age- and sex-matched controls was conducted in Enugu, Nigeria. All participants underwent transthoracic echocardiography to assess right and left ventricular systolic and diastolic function using parameters including tricuspid annular plane systolic excursion (TAPSE), tricuspid regurgitant velocity (TRV), mitral inflow velocity (MV E/A), left ventricular ejection fraction (LVEF), and mitral annular plane systolic excursion (MAPSE). Children with severe malaria had significantly higher TRV (1.3 ± 0.8 vs 0.9 ± 0.4 m/s; p = 0.001) and lower LVEF (65.5 ± 23.2 vs 69 ± 9.8; p = 0.04) than controls. Abnormal TAPSE occurred in 4% of subjects compared with none of the controls (p = 0.04). The prevalence of abnormal MRV was greater in subjects than controls (16% vs 6%; p = 0.04), while abnormal LVEF occurred in 7% versus 1% respectively (p = 0.03). Left ventricular diastolic dysfunction assessed by abnormal MAPSE was more common in subjects (32% vs 13%; p = 0.03). TAPSE positively correlated with age (r = 0.5, p < 0.001). CONCLUSION:  Children with severe malaria demonstrate significant systolic and diastolic cardiac dysfunction, particularly those with severe malarial anaemia. Early echocardiographic evaluation may improve detection and management of cardiovascular complications in severe malaria. WHAT IS ALREADY KNOWN: • Severe malaria remains a major cause of childhood morbidity and mortality, particularly in sub-Saharan Africa. Cardiovascular involvement is increasingly recognized as an important complication resulting from microvascular sequestration, endothelial dysfunction, haemolysis, inflammation, and severe anaemia. Previous studies have reported abnormalities in right and left ventricular function among children with severe malaria. Echocardiography is a useful non-invasive tool for assessing cardiac function and pulmonary hemodynamics. However, evidence on malaria-associated cardiac dysfunction remains limited, especially in African populations where malaria burden is highest. WHAT THIS STUDY ADDS: • This study evaluated cardiac function in children with severe malaria using echocardiographic parameters including TAPSE, TRV, tricuspid inflow E/A ratio, LVEF, and fractional shortening. It demonstrated significant systolic and diastolic abnormalities affecting both right and left ventricular function, particularly among children with severe malarial anaemia. The findings provide important region-specific data from Nigeria and help address the limited evidence regarding cardiovascular complications of severe malaria in African children. The study supports early echocardiographic assessment for detecting subclinical cardiac dysfunction, improving risk stratification, and enhancing clinical management in severe malaria.