1Federal University of Acre, Campus Floresta, Cruzeiro do Sul, Acre, Brazil.
2Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark.
Am J Trop Med Hyg. 2021 Mar 15;104(5):1643-1650. doi: 10.4269/ajtmh.20-1414.
Recent studies have suggested that malaria may affect the cardiovascular system. The aim of this systematic review and meta-analysis was to determine the prevalence of cardiovascular complications in symptomatic malaria patients. We searched databases such as Pubmed, Embase, Cochrane, and Web of Science (January 1950-April 2020) for studies reporting on cardiovascular complications in adults and children with malaria. Cardiovascular complications were defined as abnormalities in electrocardiogram (ECG), cardiac biomarkers, and echocardiography on admission or during outpatient examination. Studies of patients with known heart disease or cardiovascular evaluation performed after the start of intravenous antimalarial medication were excluded. The study was registered in International Prospective Register of Systematic Reviews (PROSPERO) (No.: CRD42020167672). The literature search yielded 1,243 studies, and a total of 43 studies with symptomatic malaria patients were included. Clinical studies (n = 12 adults; n = 5 children) comprised 3,117 patients, of which a majority had Plasmodium falciparum (n = 15) and were diagnosed with severe malaria (n = 13). In random-effects models of adults, the pooled prevalence estimate for any cardiovascular complication was 7% (95% CI: 5-9). No meta-analysis was conducted in children, but the range of abnormal ECG was 0-8%, cardiac biomarkers 0-57%, and echocardiography 4-9%. We analyzed 33 cases (n = 10 postmortem), in which the most common cardiovascular pathologies were myocarditis and acute coronary syndrome. All histopathological studies found evidence of parasitized red blood cells in the myocardium. Cardiovascular complications are not uncommon in symptomatic adults and children with malaria. Additional studies investigating malaria and cardiovascular disease are encouraged.
最近的研究表明，疟疾可能会影响心血管系统。本系统评价和荟萃分析的目的是确定有症状疟疾患者中心血管并发症的患病率。我们检索了 Pubmed、Embase、Cochrane 和 Web of Science 等数据库（1950 年 1 月至 2020 年 4 月），以寻找有关疟疾成人和儿童心血管并发症的研究。心血管并发症定义为入院或门诊检查时心电图（ECG）、心脏生物标志物和超声心动图的异常。排除已知心脏病或静脉抗疟药物开始后进行心血管评估的患者的研究。本研究已在国际前瞻性系统评价注册库（PROSPERO）（编号：CRD42020167672）注册。文献检索共获得 1243 项研究，共有 43 项有症状疟疾患者的研究纳入本研究。临床研究（n = 12 例成人；n = 5 例儿童）共纳入 3117 例患者，其中大多数为恶性疟原虫（n = 15）和严重疟疾（n = 13）。在成人的随机效应模型中，任何心血管并发症的汇总患病率估计为 7%（95%CI：5-9）。未对儿童进行荟萃分析，但心电图异常范围为 0-8%，心脏生物标志物 0-57%，超声心动图 4-9%。我们分析了 33 例（n = 10 例尸检）病例，其中最常见的心血管病变为心肌炎和急性冠状动脉综合征。所有组织病理学研究都发现心肌中有寄生的红细胞。有症状的成人和儿童疟疾中并不少见心血管并发症。鼓励开展更多关于疟疾和心血管疾病的研究。
