Determinants of Left Ventricular Hypertrophy and Diastolic Dysfunction in an HIV Clinical Cohort

Area of Science:

• Cardiology
• Infectious Diseases
• Public Health

Background:

• Cardiovascular disease is a leading cause of morbidity and mortality in people living with HIV (PLWH).
• Structural myocardial abnormalities, such as left ventricular hypertrophy (LVH) and diastolic dysfunction (DD), are increasingly recognized in PLWH.

Purpose of the Study:

• To investigate the determinants of structural myocardial abnormalities in PLWH.
• To identify risk factors associated with LVH and DD in this population.

Main Methods:

• Retrospective review of transthoracic echocardiograms (TTEs) from 498 PLWH between 2001 and 2012.
• Analysis of TTE data for the presence of LVH and DD.
• Statistical analysis to identify associations between cardiac abnormalities and clinical parameters, including CD4 counts and viral load.

Main Results:

• LVH was detected in 37% of PLWH by LV mass criteria and 31% by ASE LV mass index criteria.
• Definite DD was detected in 8% of PLWH.
• Higher prevalence of LVH was associated with lower CD4 counts (≤ 200 cells/mm³).
• Lower CD4 nadirs and proximal CD4 counts were associated with DD.
• Viral suppression was associated with a lower likelihood of LVH.

Conclusions:

• PLWH with a history of advanced immune suppression (low CD4 counts) are at increased risk for LVH and DD.
• Preserved immune function is associated with a lower risk of these cardiac abnormalities.
• These findings highlight the importance of monitoring cardiac health in PLWH, particularly those with a history of significant immune suppression.