Markers of preclinical vascular disease and left ventricular diastolic dysfunction in patients with HIV infection

HIV infected patients have an increased cardiovascular risk that may be linked not only to the infection itself but also to the metabolic side effects of the antiretroviral therapy.

The aim of our study was to determine markers of aortic arterial stiffness, carotid intima-media thickness (IMT) and parameters of left ventricular diastolic function and to establish the relationship between these vascular and cardiac parameters in HIV infected patients.

In this cross sectional case control study 43 patients with HIV infection and 25 healthy controls, matched for age and sex were enrolled. Aortic pulse wave velocity (PWV) and augmentation index (AIx) using an oscillometric method were measured. Carotid IMT and left ventricular systolic and diastolic function were determined by ultrasonography. Clinical status, laboratory parameters (glucose and lipid metabolism), and markers of disease activity were also recorded.

In patients with HIV infection PWV was increased when compared to controls (p=0.02), but there were not significant differences in carotid IMT (p= 0.17). There were no differences for classical risk factors between HIV infected patients and controls with the exception of triglycerides level (p<0.001). HIV infected patients had a significant reduction in E/A ratio when compared to controls (p= 0.03). Significant differences were found for age (p=0.001), PWV (0.002) and carotid IMT (p=0.02) between patients with and without left ventricular diastolic dysfunction (LVDD). In multiple regression analyze only PWV remained correlated with LVDD (OR = 2.90, 95%CI: 1.41-5.97, p=0.004).

In patients with HIV infection, without overt cardiovascular disease, arterial stiffness was increased. This finding is correlated with markers of LVDD. Increased arterial stiffness may be one of the mechanisms implicated in the alteration of left ventricular diastolic function in HIV infected patients.