Malaria caused by the Plasmodium falciparum (P.f) parasite can result in life-threatening complications. Traditionally, cardiac involvement has not been included as a frequent cause of morbidity and mortality. Cardiac damage in P.f infection is probably underdiagnosed.

To analyze the hypothesis of cardiac damage in apparently uncomplicated P.f infection with a multimodality strategy unavailable in most endemic countries.

Cardiac biomarkers, ECG and 24h ECG recording, transthoracic echocardiography with global strain analysis, and complete CMR analysis, including T2 (Fig. 1) and T1 mapping and extracellular volume quantification (ECV), were performed in patients hospitalized for malaria in a French tertiary center.

Ten cases (sex ratio: 1 – mean age: 45±13 years) imported from sub-Saharan Africa were prospectively included. Mean P.f parasitemia was 1.6±1.7%. Hs-c Troponin T and NT pro BNP were mildly increased respectively in 1 and 2 patients. 24-h ECG recording revealed>500 ventricular premature beats in 2 patients. Imaging revealed normal left and right ventricular systolic function, diastolic function and longitudinal global strain in all but one patient. CMR revealed 2 cases of focal late gadolinium enhancement consistent with the diagnosis of acute myocarditis in 1 case. ECV value was increased in 1 case (dilated cardiomyopathy). All patients were treated with piperaquine+dihydroartemisine and had a favorable outcome.

Multimodality strategy reveals some cardiac abnormalities (ventricular ectopy, myocarditis) in patients hospitalized for falciparum malaria. Specificity of such findings remains questionable in this preliminary study. Further investigation is required to conclude about the hypothesis of a significant malaria-induced cardiac.