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Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Associations Between HIV Serostatus and Cardiac Structure and Function Evaluated by 2-Dimensional Echocardiography in
Henrique Doria de Vasconcellos1, Wendy S Post1,2, Ann-Margret Ervin2
1Johns Hopkins University School of Medicine Baltimore MD.
Insights
HIV infection is linked to significant cardiac changes in men, including increased heart size and impaired function, even with effective treatment. These findings suggest a higher risk for heart failure with preserved ejection fraction in men with HIV.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Combination antiretroviral therapy has transformed HIV management, but cardiovascular complications remain a concern.
- Understanding cardiac structure and function differences in HIV-positive individuals is crucial for preventative strategies.
Purpose of the Study:
- To compare cardiac structure and function between men with and without HIV using 2D echocardiography.
- To identify associations between HIV disease severity markers and cardiac parameters.
Main Methods:
- Cross-sectional analysis of 1195 men from the Multicenter AIDS Cohort Study (MACS) with echocardiograms (2017-2019).
- Multivariable regression analyses adjusted for demographics and cardiovascular risk factors.
- Investigation of HIV disease severity markers (e.g., CD4+ T cell count, viral suppression) in HIV-positive men.
Main Results:
- HIV-positive men showed greater left ventricular mass index, larger left atrial diameter, and larger right ventricular end-diastolic area compared to HIV-negative men.
- HIV-positive men exhibited lower right ventricular function and a higher prevalence of diastolic dysfunction.
- No significant association was found between HIV serostatus and left ventricular ejection fraction; however, viral suppression was linked to increased left ventricular mass and atrial areas.
Conclusions:
- HIV seropositivity is independently associated with adverse cardiac remodeling and diastolic dysfunction, independent of left ventricular ejection fraction.
- These cardiac abnormalities may indicate a predisposition to heart failure with preserved ejection fraction in men living with HIV.
- Continued cardiovascular monitoring is essential for HIV-positive individuals, even those on effective combination antiretroviral therapy.
Abstract:
Background We aimed to investigate whether there are differences in cardiac structure and systolic and diastolic function evaluated by 2-dimensional echocardiography among men living with versus without HIV in the era of combination antiretroviral therapy. Methods and Results We performed a cross-sectional analysis of 1195 men from MACS (Multicenter AIDS Cohort Study) who completed a transthoracic echocardiogram examination between 2017 and 2019. Associations between HIV serostatus and echocardiographic indices were assessed by multivariable regression analyses, adjusting for demographics and cardiovascular risk factors. Among men who are HIV+, associations between HIV disease severity markers and echocardiographic parameters were also investigated. Average age was 57.1±11.9 years; 29% of the participants were Black, and 55% were HIV+. Most men who were HIV+ (77%) were virally suppressed; 92% received combination antiretroviral therapy. Prevalent left ventricular (LV) systolic dysfunction (ejection fraction <50%) was low and HIV serostatus was not associated with left ventricular ejection fraction. Multivariable adjustment models showed that men who were HIV+ versus those who were HIV- had greater LV mass index and larger left atrial diameter and right ventricular (RV) end-diastolic area; lower RV function; and higher prevalence of diastolic dysfunction. Higher current CD4+ T cell count ≥400 cell/mm3 versus <400 was associated with smaller LV diastolic volume and RV area. Virally suppressed men who were HIV+ versus those who were HIV- had higher indexed LV mass and left atrial areas and greater diastolic dysfunction. Conclusions HIV seropositivity was independently associated with greater LV mass index, left atrial and RV sizes, lower RV function and diastolic abnormalities, but not left ventricular ejection fraction, which may herald a future predisposition to heart failure with preserved ejection fraction among men living with HIV.
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