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Published on: January 7, 2019
[Diastolic dysfunction in human immunodeficiency virus infection]
F Hernández Hernández1, R Gascueña Rubia, P Escribano Subías
1Servicio de Cardiología.Hospital Universitario 12 de Octubre, Madrid, Spain. fhernandezh@medynet.com
Insights
Patients with human immunodeficiency virus (HIV) infection frequently exhibit silent echocardiographic abnormalities, including diastolic dysfunction. These findings suggest a direct cardiac impact of HIV, particularly in those with compromised immune status.
Area of Science:
- Cardiology
- Infectious Diseases
- Virology
Context:
- Human immunodeficiency virus (HIV) infection can affect multiple organ systems.
- Cardiac involvement in HIV is often subclinical in early stages.
- Echocardiography is a key tool for assessing cardiac structure and function.
Purpose:
- To determine the prevalence and characteristics of echocardiographic abnormalities in asymptomatic HIV-infected patients.
- To compare cardiac findings in HIV patients with a healthy control group.
- To investigate the relationship between immunologic status and cardiac dysfunction in HIV.
Summary:
- Transthoracic echocardiography revealed abnormal left ventricular relaxation and filling patterns in 125 HIV patients compared to 47 controls.
- Segmental wall-motion abnormalities (15%) and pericardial effusion (7.2%) were observed in the HIV group.
- Systolic function and left ventricular dimensions were normal and did not differ significantly between groups.
Impact:
- Silent echocardiographic abnormalities are common in HIV patients, indicating a potential direct myocardial effect of the virus.
- Diastolic dysfunction in HIV is linked to a poorer immunologic status (lower CD4 counts).
- Further prospective studies are necessary to understand the clinical prognosis of these asymptomatic cardiac changes.
Aims:
We sought to determine the prevalence and characteristics of echocardiographic abnormalities (systolic and/or diastolic dysfunction, pericardial effusion) in patients with human immunodeficiency virus infection (HIV) with no symptoms or previous history of cardiac disease, and compare them with a healthy control group.
Patients And Method:
Transthoracic echocardiography was performed in 125 patients (73% male, mean age 33.2 +/- 6.6 years) with HIV infection without cardiac involvement and 47 age and sex-matched healthy volunteers (78% male, 31.6 +/- 7.3 years). The immunologic situation was determined by CD4 lymphocyte counts.
Results:
Abnormal left ventricular relaxation and filling patterns (E/A relation 1.31 +/- 0.35 in HIV group, 1.66 +/- 0.38 in control group, p < 0.001; pressure half-time 57.5 +/- 13 in HIV group, 50.6 +/- 6.6 in control group, p < 0.001), segmental wall-motion abnormalities (15%) and pericardial effusion (7.2%) were found in patients with HIV infection. Systolic function (EF 64.8 +/- 8.3) and left ventricular dimension (diastolic diameter 4.94 +/- 0.55, systolic diameter 3.17 +/- 0.51) showed normal patterns and did not significantly differ from those of the control group.
Conclusions:
Silent echocardiographic abnormalities in patients with HIV infection are frequent suggesting a direct myocardial effect of the virus. The development of diastolic dysfunction is directly related to a worse immunologic situation. Prospective studies are needed to clarify the clinical prognosis of these asymptomatic abnormalities.
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