Echocardiographic cardiac structural Z-scores in children with severe malaria: a cross-sectional study in Southeast Nigeria

Background Severe malaria is associated with cardiovascular alterations resulting from chronic anaemia, increased cardiac output, and myocardial stress. Echocardiographic Z-scores provide standardized assessment of cardiac dimensions and function in children, but data from African populations remain limited. Objectives To evaluate echocardiographic Z-scores of cardiac structure and function among children with severe malaria and compare findings with healthy controls. Methods This comparative cross-sectional study involved children with severe malaria and age-matched healthy controls. Echocardiographic measurements of cardiac valve dimensions and functional parameters were obtained and converted to Z-scores indexed to body surface area. Comparisons were also made between children with severe malarial anaemia (SMA) and those with other forms of severe malaria. Correlations between cardiac parameters and age were assessed. Results Cardiac valve dimension Z-scores were comparable between subjects and controls (p > 0.05). However, ejection fraction was significantly lower in children with severe malaria compared with controls (65.5 ± 13.1 vs. 69.0 ± 9.8; p = 0.03). Among subjects, children with SMA had significantly lower left ventricular posterior wall diameter, interventricular septal thickness, and left ventricular internal diameter in systole compared with other severe malaria phenotypes (p < 0.05). Significant positive correlations existed between age and most Z scores of cardiac valve dimensions as well as selected functional parameters. Conclusion Children with severe malaria demonstrate preserved cardiac valve dimensions but reduced systolic function. Severe malarial anaemia is associated with alterations in selected cardiac functional parameters, underscoring the importance of echocardiographic evaluation in affected children.