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Published on: September 5, 2017
Imaging and Circulating Biomarker-Defined Cardiac Pathology in Pulmonary Tuberculosis: A Systematic Review
Marcello S Scopazzini1,2, Katherine J Hill3, Edith D Majonga4,5
1Department of Non-Communicable Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom.
Insights
Pulmonary tuberculosis (PTB) is linked to higher cardiovascular disease mortality, with pericardial effusion being the most common cardiac issue found. More research is needed to understand the full spectrum of cardiac pathology in PTB patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Radiology
Background:
- Pulmonary tuberculosis (PTB) is associated with increased cardiovascular disease (CVD) mortality, but the underlying mechanisms are not well understood.
- This systematic review synthesizes evidence on cardiac pathology prevalence in PTB patients using cardiac imaging and biomarkers.
Approach:
- Systematically searched databases for studies on PTB patients evaluating cardiac pathology via echocardiography, cardiac MRI, PET, CT coronary angiography, and cardiac biomarkers.
- Included seven studies with 1,333 participants, analyzing various cardiac imaging modalities and biomarker assessments.
Key Points:
- Pericardial effusion was the most frequently reported cardiac pathology in PTB, with prevalence ranging from 14.1-55.9%.
- Left ventricular systolic impairment occurred in 0-4.25% of patients.
- Pericardial and/or myocardial inflammation prevalence ranged from 0.6-21.8%.
- Cardiac biomarker assessment was limited, with only one study evaluating troponin and BNP.
Conclusions:
- Pericardial effusion is the most common cardiac pathology identified in patients with PTB.
- Evidence on myocardial or coronary disease using advanced imaging and cardiac biomarkers in PTB is limited.
- Further studies are required to determine the prevalence and disease mechanisms of cardiac pathology in PTB.
Background:
Pulmonary tuberculosis (PTB) is associated with increased cardiovascular disease (CVD) mortality. However, underlying pathophysiological mechanisms are poorly understood. This systematic review aims to synthesise the evidence on the prevalence of cardiac pathology based on cardiac imaging and circulating biomarkers in patients with PTB.
Methods:
We systematically searched databases for studies in patients with PTB evaluating cardiac pathology (pericardial effusion or left ventricular dysfunction) on echocardiography; late gadolinium enhancement on cardiac magnetic resonance imaging (CMR); myocardial inflammation on positron-emission tomography (PET); coronary artery stenosis on CT coronary angiography (CTCA); and cardiac troponin (cTn) and/or B-type natriuretic peptides (BNP) assessment.
Results:
Seven studies were included across 1,333 participants with PTB. Four studies used echocardiography (n = 1,111). The prevalence of pericardial effusion ranged from 14.1-55.9%; and left ventricular systolic impairment from 0-4.25%. One study used CMR and PET-CT (n = 26); and two studies used PET-CT alone (n = 196). The prevalence of pericardial and/or myocardial inflammation ranged from 0.6-21.8%. One study evaluated cTn, Creatine Kinase-MB (CK-MB), and BNP (n = 800), of whom 246 had raised cTn. No study reported cardiac pathology using CTCA.
Conclusion:
Pericardial effusion is the commonest reported cardiac pathology in PTB. To date, only one study has evaluated cardiac biomarkers and studies evaluating myocardial or coronary disease on advanced imaging remain limited. Our study highlights the paucity of evidence on the presence of cardiac pathology in PTB. Studies are required to determine the prevalence of, and disease mechanisms associated with cardiac pathology among patients with PTB.
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