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Subclinical Left Ventricular Systolic Dysfunction in HIV Patients: Prevalence and Associations with Carotid
Eleni Athanasiadi1, Maria Bonou1, Dimitrios Basoulis2
1Department of Cardiology, Laiko General Hospital, 115 27 Athens, Greece.
Insights
Subclinical left ventricular systolic dysfunction (LVSD) and carotid atherosclerosis are more common in people living with HIV (PLWH). Carotid atherosclerosis and higher BMI are linked to impaired heart function in PLWH.
Area of Science:
- Cardiology
- Infectious Diseases
- Vascular Medicine
Background:
- Human immunodeficiency virus (HIV) infection is associated with multifactorial cardiovascular issues.
- Early detection of myocardial dysfunction and peripheral artery damage in people living with HIV (PLWH) is crucial for timely intervention.
- Limited data exists on pre-symptomatic cardiovascular complications in PLWH.
Purpose of the Study:
- To investigate the association between global longitudinal strain (GLS), an indicator of subclinical left ventricular systolic dysfunction (LVSD), and various clinical factors in PLWH.
- To compare cardiovascular parameters between PLWH and age/sex-matched controls.
- To identify predictors of LVSD in PLWH without a history of cardiovascular disease.
Main Methods:
- Prospective enrollment of 103 PLWH and 52 controls.
- Assessment of GLS using two-dimensional speckle-tracking echocardiography.
- Measurement of carotid intima-media thickness (IMT), atherosclerotic plaque presence, and carotid artery temperature using ultrasonography and microwave radiometry.
- Analysis of basic blood panel measurements, including hsTnT and NT-proBNP.
Main Results:
- PLWH exhibited significantly higher relative wall thickness, rates of LVSD, and carotid artery atherosclerosis compared to controls.
- LVSD in PLWH was independently associated with carotid atherosclerosis and body mass index (BMI).
- No significant differences in microwave radiometry parameters, NT-proBNP, hs-TnT, or C-reactive protein were observed between PLWH with and without LVSD.
Conclusions:
- Subclinical LVSD and carotid atherosclerosis are more prevalent in PLWH, suggesting a link with HIV infection.
- Carotid atherosclerosis and increased adiposity are independently associated with impaired GLS in HIV-infected individuals.
- These findings highlight the importance of cardiovascular monitoring in PLWH.
Background:
Human immunodeficiency virus (HIV) is mainly detected in young, otherwise healthy, individuals. Cardiomyopathy and peripheral artery disease affecting these patients appears to be multifactorial. Prompt and potentially more effective implementation of therapeutic measures could be enabled by pre-symptomatic diagnosis of myocardial dysfunction and peripheral artery damage. However, limited data is available to date on this specific topic. Μethods: We investigated the association between global longitudinal strain (GLS), an established index of subclinical left ventricular systolic dysfunction (LVSD) assessed by two-dimensional speckle-tracking echocardiography, and: (a) patient history; (b) demographic and clinical baseline characteristics; (c) carotid intima-media thickness (IMT) and the presence of carotid atherosclerotic plaque(s), measured by ultrasonography; (d) temperature difference (ΔT) along each carotid artery, measured by microwave radiometry; and (e) basic blood panel measurements, including high-sensitivity troponin-T (hsTnT) and NT-proBNP in people living with HIV (PLWH) and no history of cardiovascular disease.
Results:
We prospectively enrolled 103 consecutive PLWH (95% male, age 47 ± 11 years, anti-retroviral therapy 100%) and 52 age- and sex-matched controls. PLWH had a significantly higher relative wall thickness (0.38 ± 0.08 vs. 0.36 ± 0.04, p = 0.048), and higher rate of LVSD (34% vs. 15.4%, p = 0.015), and carotid artery atherosclerosis (28% vs. 6%, p = 0.001) compared with controls. Among PLWH, LVSD was independently associated with the presence of carotid atherosclerosis (adj. OR:3.09; 95%CI:1.10-8.67, p = 0.032) and BMI (1.15; 1.03-1.29, p = 0.017), while a trend for association between LVSD and left ventricular hypertrophy was also noted (3.12; 0.73-13.33, p = 0.124). No differences were seen in microwave radiometry parameters, NT-proBNP, hs-TnT and c-reactive protein between PLWH with and without LVSD.
Conclusions:
Subclinical LVSD and carotid atherosclerosis were significantly more frequent in PLWH compared to a group of healthy individuals, implying a possible link between HIV infection and these two pathological processes. Carotid atherosclerosis and increased adiposity were independently associated with impaired GLS in HIV-infected individuals.
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