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. 2024 Dec 5;4(1):101427.
doi: 10.1016/j.jacadv.2024.101427. eCollection 2025 Jan.

Cardiovascular Involvement in Tuberculosis Patients Treated in Southern Africa

Daryoush Samim  1 , Guy Muula  2 , Nicolas Banholzer  3 , Douglas Chibomba  4 , Sihle Xulu  5 , Carolyn Bolton  2 , Denise Evans  6 , Lisa Perrig  3 , Stefano De Marchi  1 , Gunar Günther  7 , Matthias Egger  3   8   9 , Thomas Pilgrim  1 , Lukas Fenner  3 ; IeDEA Southern Africa (IeDEA-SA)
Affiliations

Cardiovascular Involvement in Tuberculosis Patients Treated in Southern Africa

Daryoush Samim et al. JACC Adv. .

Abstract

Background: Tuberculosis (TB) is the leading cause of death among people with HIV and a major global health challenge. Subclinical cardiovascular manifestations of TB are poorly documented in high TB and HIV burden countries.

Objectives: The purpose of this study was to quantify the prevalence of cardiovascular involvement in TB patients and investigate changes after completion of anti-TB treatment.

Methods: HIV-positive and HIV-negative patients diagnosed with pulmonary TB between October 2022 and November 2023 were enrolled from 2 tertiary care hospitals in Zambia and South Africa. Standardized transthoracic echocardiography (TTE) was conducted at TB diagnosis and after 6 months of anti-TB treatment. Cross-sectional and longitudinal analyses assessed pericardial effusion, thickening, or calcification, with and without signs of pericardial constriction.

Results: A total of 286 TB patients (218 [76%] men, 109 [38%] people with HIV, median age 35 years) underwent TTE at TB diagnosis, of whom 105 participants had a second TTE after completion of treatment. At TB diagnosis, 134 (47%) had pericardial effusions, 86 (30%) thickening, 7 (2%) calcifications, 103 (42%) signs of constriction, and 13 (12%) had definite diagnosis of constriction. After TB treatment, pericardial effusions (47% vs 16%, P < 0.001) and pericardial thickenings (30% vs 15%, P = 0.002) became less prevalent. Pericardial calcifications (2% vs 1%, P = 0.4), signs of constrictions (42% vs 38%, P = 0.4), and definite diagnosis of constriction (12% vs 14%, P = 0.8) were similar.

Conclusions: Cardiac involvement is frequent in newly diagnosed TB patients. Early pericardial changes may be reversed with anti-TB treatment. Echocardiographic screening facilitates early detection and timely management of cardiovascular involvement in TB patients.

Keywords: HIV; constrictive pericarditis; echocardiography; pericardial effusion; tuberculosis.

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Conflict of interest statement

Research reported in this publication was supported by the 10.13039/100000060National Institute of Allergy And Infectious Diseases of the 10.13039/100000002National Institutes of Health under Award Number U01AI069924 and the Swiss National Science Foundation (SNSF grant 32FP30-189498). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the SNSF. Dr Pilgrim reports research grants to the institution from Biotronik, Boston Scientific, Edwards Lifesciences, and consultancy/speaker fees from Biotronik, Edwards Lifesciences, Abbott, Biosensors, Medtronic, and HighLife. Dr Samim received funding for an online course from Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Central Illustration
Central Illustration
Cardiovascular Involvement in Tuberculosis Patients Treated in Southern Africa TTE = transthoracic echocardiography; TB = tuberculosis.
Figure 1
Figure 1
Echocardiographic Findings of Pericardial Constriction Various signs of constriction observed during the study.
Figure 2
Figure 2
Changes of Pericardial Pathologies Between Baseline and End of Anti-Tuberculosis Treatment Proportion of patients with pericardial abnormalities in patients with follow-up visits (105 patients) at the start and at the end of anti-TB treatment. Shown is the mean (vertical bars) and standard deviation (error bars) of the proportion after data imputation. TB = tuberculosis.
Figure 3
Figure 3
Pericardial Developments Through Anti-Tuberculosis Treatment and Six Months After Completed Anti-Tuberculosis Treatment Changes in pericardial abnormalities following anti-TB treatment in patients with post-treatment echocardiography images (12 patients). Abbreviation as in Figure 2.
See this image and copyright information in PMC

References

    1. Global, regional, and National sex differences in the global burden of tuberculosis by HIV status, 1990-2019: results from the Global Burden of Disease Study 2019. Lancet Infect Dis. 2022;22(2):222–241. - PMC - PubMed
    1. Obonyo N.G., Etyang A.O. Cardiovascular health priorities in sub-saharan Africa. SN Compr Clin Med. 2023;5(1):262.
    1. Minja N.W., Nakagaayi D., Aliku T., et al. Cardiovascular diseases in Africa in the twenty-first century: gaps and priorities going forward. Front Cardiovasc Med. 2022;9 - PMC - PubMed
    1. Keates A.K., Mocumbi A.O., Ntsekhe M., Sliwa K., Stewart S. Cardiovascular disease in Africa: epidemiological profile and challenges. Nat Rev Cardiol. 2017;14(5):273–293. - PubMed
    1. van Heerden J.K., Louw E.H., Thienemann F., Engel M.E., Allwood B.W. The prevalence of pulmonary hypertension in post-tuberculosis and active tuberculosis populations: a systematic review and meta-analysis. Eur Respir Rev. 2024;33(171) - PMC - PubMed