Figure 1
Preferred Reporting Items For Systematic Reviews And Meta-Analyses (PRISMA) diagram. Figure 1 describes our search strategy, including all relevant databases and subsequent reference checks employed in our study. We further describe our study selection and exclusion process culminating in our final seven included studies.
Table 1
Study characteristics for seven included studies. This table describes important features of each study included in this systematic review, including number of patients with PTB, the proportion of participants living with HIV, country of origin, method of TB diagnosis, and imaging method and outcome used to determine cardiac pathology. Imaging methods are: *TTE = transthoracic echocardiography; **Biomarkers = serum cardiac troponin T (cTnT), Creatine-Kinase MB (CK-MB), and non-terminal pro-B type natriuretic peptide (NT-pro-BNP); †CMR = cardiac magnetic resonance imaging; ‡FDG-PET = 18F-fluorodeoxyglucose positron emission tomography; §LGE = late gadolinium enhancement on CMR, a marker of myocardial inflammation; ||SUV max = maximum standardised uptake value for 18F-fluorodeoxyglucose positron emission tomography.
| STUDY NAME | STUDY SUMMARY | STUDY PERIOD | STUDY DESIGN | COUNTRY | NUMBER OF PARTICIPANTS | CONTROL POPULATION | POPULATION SOURCE AND STUDY POPULATION | TB POPULATION (% OF TOTAL POPULATION) | PROPORTION OF PATIENTS LIVING WITH HIV (N (%)) | TB DIAGNOSIS | OUTCOME MEASURE (IMAGING AND BIOMARKERS) |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Transthoracic Echocardiography (TTE) Studies | |||||||||||
| Casas, 2000 | Cross-sectional study evaluating prevalence of pericardial effusion in patients with pulmonary TB (PTB) | 1995–01 1997–12 | Cross-sectional Study | Spain | 85 | No | Hospital inpatients—all consecutive new cases of PTB | 100 | 36/85 (42.3%) | Microbiologically confirmed PTB | TTE*: Presence of pericardial effusion |
| Patel, 2010 | Cross-sectional study evaluating the sensitivity and specificity of point-of-care ultrasound (POCUS) among patients with TB | 2004–08 2004–10 | Cross-sectional Study | South Africa | 267 | No | Hospital inpatients—consecutive patients with microbiologically confirmed PTB or EPTB | 63.7 | 201/267 (75%) | Microbiologically confirmed PTB | TTE: Presence of pericardial effusion |
| Kahn, 2020 | Prospective cohort study to evaluate the sensitivity and specificity of POCUS to detect PTB among patients presenting with two or more TB symptoms | 2016–03 2017–08 | Cohort Study | Malawi | 181 | Yes—participants without TB | Outpatients—all participants with two or more TB symptoms recruited consecutively | 30.9 | All PLHIV | Microbiologically confirmed PTB | TTE: Presence of pericardial effusion |
| Patil, 2023 | Prospective follow-up study of consecutive patients newly diagnosed with PTB to describe features of cardiac dysfunction | 2016–2020 | Cohort Study | India | 800 | No | Respiratory outpatients—all patients with newly diagnosed pulmonary tuberculosis | 100 | 0 (PLHIV excluded from study) | Microbiologically confirmed PTB | TTE: Global hypokinesia (visual assessment) Left ventricular systolic dysfunction Left ventricular diastolic dysfunction Biomarkers**: CK-MB, cTnT, and NT-pro-BNP levels (no cut-offs described) |
| Cardiac Magnetic Resonance Imaging (CMR) and 18Fluorodeoxyglucose Positron-Emission-Tomography (FDG-PET) Studies | |||||||||||
| Mukasa, 2022 | Nested cross-sectional study describing CMR† and FDG-PET‡ features among patients enrolled to the StatinTB trial who recently completed TB treatment | Ongoing | Cross-sectional Study | South Africa | 26 | No | Patients enrolled in the StatinTB trial | 100 | 6/26 23.1% | Microbiologically confirmed PTB | CMR†: Left ventricular end systolic volume FDG-PET‡: Persistent lung inflammation |
| Ankrah, 2019 | Retrospective cross-sectional study describing radiological features on FDG-PET among patients established on anti-tuberculous therapy in Australia | Not stated | Cross-sectional Study | Australia | 96 | No | Radiology department—all cases on anti-tuberculous therapy included in the study | 100 | Not stated | Not stated | FDG-PET: myocardial SUV max|| |
| Bomanji, 2020 | Cross sectional study describing FDG-PET features among consecutively recruited patients with extrapulmonary tuberculosis (EPTB) in six different countries | Not stated | Cross-sectional Study | India, Pakistan, Thailand, Serbia, Bangladesh | 358, of whom 100 had PTB | No | Hospital inpatients—all consecutive new diagnoses of extra-pulmonary tuberculosis | 100 | 0 (PLHIV excluded from study) | Not stated | FDG-PET SUV max in all anatomical sites |
Figure 2
Cartogram – geographical distribution of included studies by country TB endemicity. This cartogram maps the geographical distribution of studies included in this systematic review. In dark red are countries defined as high-burden for tuberculosis incidence and prevalence as per World Health Organization; light pink indicates countries considered low-burden for tuberculosis. Arrows and boxes indicate the number of studies per country and number of participants with tuberculosis included in each relevant study.
Table 2
Population characteristics of seven included studies. This table describes the population characteristics of included studies and estimated prevalence rates of outcomes of interest: pericardial effusion; presence of left ventricular systolic dysfunction; and myocardial inflammation according to study-specific parameters. For Ankrah et al.: *patients with FDG SUVmax >10 consistent with cardiac inflammation on FDG-PET; for Bomanji et al.: †this was the prevalence of FDG SUV max uptake in pericardium consistent with pericardial inflammation; and for Mukasa et al. this was ‡Persistent lung inflammation defined as total lung glycolysis (TLG) >50 SUV/ml associated with left ventricular end systolic volume indicative of cardiac dysfunction.
| SOURCE | NUMBER OF PATIENTS WITH PTB | MEN, % | WOMEN, % | AGE, MEAN, YEARS | TIMING OF IMAGING AND TB DIAGNOSIS | PARTICIPANTS LIVING WITH HIV, n/N, (%) | PRESENCE OF PERICARDIAL EFFUSION >0.5 CM, n/N, (%) | PRESENCE OF LEFT VENTRICULAR SYSTOLIC DYSFUNCTION, n/N, (%) | MYOCARDIAL INFLAM MATION, n/N, % | CARDIAC DYSFUNCTION ASSOCIATED WITH PERSISTENT LUNG INFLAMMATION, n/N, % |
|---|---|---|---|---|---|---|---|---|---|---|
| Echocardiographic studies assessing pericardial effusion | ||||||||||
| Casas et al., 2000 | 85 | 72.9 | 27.1 | 39.7 | Participants imaged at TB diagnosis | 36/85(42.4) | 12/85(14.1) | – | – | |
| Patel et al., 2010 | 170 | NR | NR | 36.4 | Participants imaged at TB diagnosis | 145/170(85.2) | 95/170(55.9) | – | – | |
| Kahn et al., 2020 | 56 | 51.7 | 48.2 | 39 | Participants imaged at TB diagnosis | 56/56(100) | 24/56(42.9) | – | – | |
| Echocardiographic studies assessing left ventricular systolic function | ||||||||||
| Patil et al., 2023 | 800 | 56 | 44 | NR | Participants imaged at TB diagnosis | 0/800 | – | 34/800(4.25) | – | |
| Positron emission tomography studies assessing vascular inflammation | ||||||||||
| Ankrah et al., 2019 | 96 | 49 | 51 | 37.4 | 67% of patients imaged within first two months of TB diagnosis | NR | – | – | 21/96*(21.8) | |
| Bomanji et al., 2020 | 100 | 47 | 53 | 33 | Participants imaged within two weeks of TB diagnosis | 0 | – | – | 2/358†(0.6) | |
| Studies evaluating both positron emission tomography and cardiac magnetic resonance imaging | ||||||||||
| Mukasa et al., 2022 | 26 | 61.5 | 38.5 | 37.8 | Participants imaged at 24-week following TB diagnosis (completion of treatment) | 6/26 (23.1) | NR | – | 11/26‡ (42.3) | |
| ART | antiretroviral therapy |
| BNP | brain natriuretic peptides |
| CKMB | creatine kinase MB |
| CMR | cardiac magnetic resonance imaging |
| CTCA | computed tomography coronary angiography |
| cTn | cardiac troponins |
| cTnT | cardiac troponin T |
| CVD | cardiovascular diseases |
| EPTB | extrapulmonary tuberculosis |
| FDG | fluorodeoxyglucose |
| HICs | high-income countries |
| HIV | human immunodeficiency virus |
| LGE | late gadolinium enhancement |
| LMICs | low- and middle-income countries |
| LVEF | left ventricular ejection fraction |
| LVESV | left ventricular end systolic volume |
| NT-pro-BNP | non-terminal pro-B type natriuretic peptide |
| PET | positron emission tomography |
| PH | pulmonary hypertension |
| PLHIV | people living with HIV |
| PLI | persistent lung inflammation |
| PTLD | post-TB lung disease |
| PTB | pulmonary tuberculosis |
| SIC | sepsis-induced cardiomyopathy |
| SSA | sub-Saharan Africa |
| SUV | standardised uptake value |
| TB | tuberculosis |
| TB-HIV | tuberculosis and HIV co-infection |
| TOE | transoesophageal echocardiography |
| TTE | transthoracic echocardiography |
| WHO | World Health Organization |