Subclinical myocardial dysfunction in pulmonary tuberculosis as a precursor of heart failure: a strain imaging study

Background

Pulmonary tuberculosis causes systemic inflammation that may involve the myocardium. Overlapping cardiopulmonary symptoms often delay recognition of cardiac involvement, leading to underdiagnosed subclinical myocardial dysfunction and increased risk of heart failure.

Objectives

1. To evaluate subclinical myocardial dysfunction as an early heart failure phenotype with help of speckle tracking in active pulmonary tuberculosis.

2. To assess relationship between systemic inflammation (C-reactive protein), hemodynamic parameters, nutritional status and myocardial dysfunction relevant to heart failure risk.

3. To study reversibility of myocardial dysfunction and related parameters following completion of therapy.

Design and Method

100 patients with active pulmonary tuberculosis above 18 years of age with unexplained tachycardia/tachypnea with normal LVEDP on echocardiography were included in this prospective observational study. Patients with HIV, on chemotherapeutic agents, radiotherapy and immunosuppressive drugs, diabetes mellitus, hypertension, stroke and known cardiovascular disorders were excluded. Heart rate, Blood pressure indices, weight ,BMI, CRP and echocardiography with speckle tracking was measured at initiation and treatment completion and were compared.

Results

At treatment initiation, 68% of patients showed impaired GLS (mild 20%, moderate 37%, severe 11%). GLS correlated negatively with CRP (p<0.001) but not with hemodynamic or nutritional parameters. After completion of therapy, GLS improved significantly (p<0.001) and showed significant negative correlation with CRP, heart rate and rate pressure product, and positive correlation with blood pressure, weight and BMI. CRP, heart rate and RPP decreased significantly, while blood pressure, weight and BMI increased; pulse pressure remained unchanged.

Conclusion

Speckle tracking echocardiography identified subclinical myocardial dysfunction consistent with early heart failure phenotype in patients with active pulmonary tuberculosis. Significant improvement in myocardial strain parameters after anti-tubercular therapy suggest that inflammation mediated myocardial impairment in tuberculosis is potentially reversible as a modifiable contributor to early heart failure development. Early strain imaging may aid in identification of patients at risk for heart failure before the onset of overt clinical disease.Comparison of variablesFor image description, please refer to the figure legend and surrounding text.GLS correlation with CRP and BMIFor image description, please refer to the figure legend and surrounding text.