Echocardiographic findings in children with malaria: a systematic review and narrative synthesis

Cardiovascular involvement has been described in children with severe malaria, but reported echocardiographic findings are heterogeneous. Some studies demonstrate transient haemodynamic abnormalities or pulmonary pressure elevation, whereas others report preserved ventricular function. We therefore updated and reframed the evidence base to describe the spectrum of echocardiographic findings rather than assume that cardiac dysfunction is universal. To synthesize and critically describe the echocardiographic findings reported in children with malaria, characterize the spectrum of cardiac structural, functional and haemodynamic abnormalities, explore factors that may explain differences between studies, and identify important methodological gaps in the existing evidence. This systematic review was structured according to PRISMA 2020. Eight predefined eligibility criteria required studies to include children/adolescents aged ≤ 18 years with laboratory-confirmed malaria; evaluate cardiac function using transthoracic echocardiography; report at least one echocardiographic structural or functional measure; use an eligible observational or interventional design; be a full-text peer-reviewed article; be published in English; provide separately extractable paediatric data where adults were also enrolled; and satisfy the prespecified publication/design exclusions. The original search covered the six prespecified databases from inception to 30 April 2025; the archived export preserved yields for five databases, while the historical AJOL yield was not preserved. A new post-search evidence update was undertaken through systematic screening of the supplied 174-reference bibliography, backward and forward citation checking, and current bibliographic surveillance through 10 September 2026. Seven eligible observational studies involving 550 children with malaria were included. Studies were conducted in Kenya, Mali, Mozambique, Uganda, Ghana and Nigeria. Findings were heterogeneous. Yacoub et al. reported mild admission abnormalities that improved during follow-up. Janka et al. reported increased pulmonary arterial pressures and myocardial wall stress. Mocumbi et al. and Murphy et al. reported largely preserved ventricular function. Nguah et al. and Kotlyar et al. demonstrated high-output physiology associated with anaemia rather than generalized systolic failure. The 2026 Nigerian study reported higher tricuspid regurgitant velocity, lower mean LVEF and higher frequencies of abnormal TAPSE, MRV and MAPSE compared with controls. No quantitative pooling was performed because of substantial clinical and methodological heterogeneity. Echocardiographic abnormalities can occur during paediatric malaria, but the available evidence does not support a single universal phenotype of cardiac dysfunction. Findings range from preserved ventricular function to transient haemodynamic disturbance, pulmonary pressure elevation and selected right- or left-sided functional abnormalities. Severe anaemia and acute haemodynamic state appear important modifiers.