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HIV and pericardial fat are associated with abnormal cardiac structure and function among Ugandans
Jonathan Buggey1, Leo Yun2, Chung-Lieh Hung3
1Cardiology, University Hospitals Harrington Heart & Vascular Institute, Cleveland, Ohio, USA.
Insights
In Uganda, HIV infection is linked to altered pericardial fat (PCF) quantity and density, which are associated with abnormal heart structure and function in people living with HIV (PLHIV). This study highlights PCF as a potential indicator of cardiac issues in this population.
Area of Science:
- Cardiology
- Infectious Diseases
- Radiology
Background:
- People living with HIV (PLHIV) exhibit altered fat distribution and increased heart failure risk.
- The relationship between pericardial fat (PCF) characteristics and cardiac dysfunction in HIV-infected individuals, particularly in Sub-Saharan Africa, remains unclear.
Purpose of the Study:
- To investigate the association between pericardial fat (PCF) volume and radiodensity with cardiac structure and function in HIV-infected patients in Uganda.
- To compare cardiac parameters in HIV-positive individuals on antiretroviral therapy with age- and sex-matched HIV-negative controls.
Main Methods:
- A comparative study involving 100 HIV-positive and 100 HIV-negative Ugandan adults (>45 years) with at least one cardiovascular disease risk factor.
- Cardiac structure and function assessed using ECG-gated non-contrast cardiac CT and transthoracic echocardiography with speckle tracking strain imaging.
- Multivariable regression models analyzed the association of PCF with echocardiographic outcomes, adjusting for traditional risk factors.
Main Results:
- HIV-positive individuals showed lower BMI and diabetes rates but higher LV mass index (LVMI) and worse LV global longitudinal strain (GLS) compared to controls.
- Adjusted analyses revealed that PCF volume was significantly associated with increased LVMI and worse LV GLS.
- PCF radiodensity was also significantly associated with worse LV GLS (p<0.05 for all significant associations).
Conclusions:
- HIV infection in Uganda is associated with changes in pericardial fat (PCF) volume and density.
- Both PCF volume and density are linked to abnormal cardiac structure (increased LVMI) and function (worse LV GLS) in HIV-infected individuals.
- These findings suggest PCF is a relevant factor in cardiac abnormalities observed in HIV patients in this region.
Objectives:
To examine the relationship between pericardial fat (PCF) and cardiac structure and function among HIV-infected patients in the sub-Saharan African country of Uganda. People living with HIV (PLHIV) have altered fat distribution and an elevated risk for heart failure. Whether altered quantity and radiodensity of fat surrounding the heart relates to cardiac dysfunction in this population is unknown.
Methods:
One hundred HIV-positive Ugandans on antiretroviral therapy were compared with 100 age and sex-matched HIV-negative Ugandans; all were >45 years old with >1 cardiovascular disease risk factor. Subjects underwent ECG-gated non-contrast cardiac CT and transthoracic echocardiography with speckle tracking strain imaging. Multivariable linear and logistic regression models were used to explore the association of PCF with echocardiographic outcomes.
Results:
Median age was 55% and 62% were female. Compared with uninfected controls, PLHIV had lower body mass index (27 vs 30, p=0.02) and less diabetes (26% vs 45%, p=0.005). Median left ventricular (LV) ejection fraction was 67%. In models adjusted for traditional risk factors, HIV was associated with 10.3 g/m2 higher LV mass index (LVMI) (95% CI 3.22 to 17.4; p=0.005), 0.87% worse LV global longitudinal strain (GLS) (95% CI -1.66 to -0.07; p=0.03) and higher odds of diastolic dysfunction (OR 1.96; 95% CI 0.95 to 4.06; p=0.07). In adjusted models, PCF volume was significantly associated with increased LVMI and worse LV GLS, while PCF radiodensity was associated with worse LV GLS (all p<0.05).
Conclusions:
In Uganda, HIV infection, PCF volume and density are associated with abnormal cardiac structure and function.
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