Pre-viva seminar : Marcello Scopazzini - TB and the heart - 23/1/26

Marcello Scopazzini will be presenting at his pre-viva seminar on Friday the 23rd of January 2026, at 13:00 GMT.

Zoom details :

Link

Meeting ID: 826 2501 0155

Password: 058111

Further details :

Over one in four deaths from TB occur in Sub-Saharan Africa, where Human immunodeficiency virus (HIV) remains prevalent and cardiac disease burden is rapidly increasing. The relationship between cardiac disease and pulmonary TB (PTB) remains poorly understood, and the impact of HIV co-infection has not been systematically studied. The goal of this PhD was to understand the burden of and risk factors associated with cardiac disease in people with PTB living with and without HIV.

This PhD comprised of three studies, the first of which was a systematic review describing imaging- and biomarker-defined cardiac pathology in people with PTB. Across seven studies, pericardial effusion was present in up to 55% of participants; prevalent myocardial inflammation in up to 21.6% of participants; and one study reported raised cardiac Troponin (cTn) levels consistent with myocardial injury.

The next two studies - the TB-HEART studies - were a cross-sectional and longitudinal cohort study to 1) determine the prevalence of and risk factors for echocardiography and/or cardiac biomarker defined cardiac pathology in people with and without PTB in Zambia, 2) explore its association with clinical and/or functional outcomes at TB treatment completion, and 3) to describe the natural history of cardiac pathology over time. 

Between November 1st, 2023, and October 15th, 2025, 252 participants with PTB and 127 matched comparators without PTB were recruited. Prevalence of cardiac pathology in people with PTB was 39.3% compared to 11.8% in comparator participants (adjusted odds ratio [OR] 3.66, 95% CI 1.90-7.05) and was associated with male sex, increasing CRP and BNP, but not with HIV, BMI or Troponin. Nearly half of participants had evidence of severe physiological derangement consistent with sepsis at diagnosis, which was associated with malnutrition,  untreated HIV and CRP. Cardiac pathology and cardiac and inflammatory biomarkers improved substantially across all participants and were not associated with either unsuccessful TB outcome or functional impairment at treatment completion. A substantial proportion of patients with baseline constrictive physiology had evidence of persisting pathology at treatment completion.

This PhD established that cardiac pathology is substantially under-reported in people with PTB living with and without HIV, is likely to be driven by inflammation, and is associated with cardiac remodelling at TB diagnosis. Whilst cardiac pathology largely improved with treatment, a subgroup of patients with persisting constrictive physiology was identified. Further studies are needed to better delineate the underlying mechanisms driving PTB-associated cardiac disease and how it may impact survival after TB.