Impact of HIV infection on cardiac deformation
Lígia Mendes1, Daniela Silva2, Carla Miranda1
1Cardiology Department, Hospital de São Bernardo, Setúbal, Portugal.
Insights
Human immunodeficiency virus (HIV) infection can cause subtle myocardial deformation abnormalities, detectable by strain and strain rate imaging, even without cardiovascular disease. These findings indicate early markers of cardiac injury in HIV patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- Human immunodeficiency virus (HIV) infection is associated with cardiovascular complications.
- Early detection of myocardial dysfunction in asymptomatic HIV patients is crucial for timely intervention.
- Established cardiovascular disease is often absent in HIV-infected individuals, necessitating sensitive diagnostic tools.
Purpose of the Study:
- To detect left ventricular myocardial function abnormalities in asymptomatic HIV-infected patients without established cardiovascular disease.
- To evaluate the utility of echocardiography, including tissue Doppler imaging (TDI) and 2D speckle tracking, in identifying subclinical cardiac changes.
- To identify specific strain and strain rate parameters indicative of myocardial injury in HIV infection.
Main Methods:
- Echocardiography, including conventional imaging and pulsed tissue Doppler imaging (TDI), was performed on 50 asymptomatic HIV-infected patients and 20 healthy controls.
- Pulsed tissue Doppler imaging (TDI) was used to obtain basal segment strain rate for systolic strain rate (SRS), early diastolic strain rate (SRE), and late diastolic strain rate (SRA).
- Longitudinal, radial, and circumferential strain were assessed using 2D speckle tracking.
Main Results:
- HIV-infected patients showed significant differences in E wave, longitudinal strain, SRS, and SRE compared to controls.
- Systolic strain rate (SRS) and early diastolic strain rate (SRE) demonstrated independent value in differentiating HIV-infected patients from controls.
- Despite the absence of established cardiovascular disease, subtle myocardial deformation abnormalities were observed in the HIV-infected cohort.
Conclusions:
- Strain and strain rate imaging can detect myocardial deformation abnormalities in HIV-infected individuals without cardiovascular disease.
- These imaging techniques reveal potential markers of myocardial injury, even in the early stages of HIV infection.
- Myocardial function assessment using strain and strain rate is valuable for monitoring cardiac health in HIV patients.
Aim:
The aim of this study was to detect abnormalities in left ventricular myocardial function due to HIV (human immunodeficiency virus) infection without established cardiovascular disease.
Methods:
An echocardiogram was performed in 50 asymptomatic HIV-infected patients (age 41 ± 6 years, 64% male) and in 20 healthy individuals. Conventional echocardiography and pulsed tissue Doppler imaging (TDI) were performed according to the guidelines. The strain rate of the basal segments was obtained with color tissue Doppler and used to evaluate systolic strain rate (SRS), early diastolic strain rate (SRE) and late diastolic strain rate (SRA). Longitudinal, radial and circumferential strain were assessed by 2D speckle tracking.
Results:
The mean duration of HIV infection was 10 ± 5 years, CD4 count was 579 ± 286 cells/mm³, 32% had detectable viral load, and 86% were under treatment. Of the HIV-infected patients, one had grade 1 diastolic dysfunction. The groups were not different except for E wave (HIV 0.72 ± 0.17 m/s vs. control 0.84 ± 0.16 m/s, p=0.01), longitudinal strain (-19.5 ± 1.9% vs. -21 ± 2%, p=0.005), SRS (-1.1 ± 0.28 s⁻¹ vs. -1.3 ± 0.28 s⁻¹, p=0.02) and SRE (1.8 ± 0.4 s⁻¹ vs. 2.2 ± 0.4 s⁻¹, p<0.001), but only SRS (p=0.03, 95% CI 0.036; 0.67) and SRE (p=0.001, 95% CI -0.599; -0.168) had independent value.
Conclusion:
In an HIV-infected population without established cardiovascular disease, myocardial deformation abnormalities can be detected with strain and strain rate, revealing markers of myocardial injury.
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