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Left Atrial Mechanics and Diastolic Function Among People Living With Human Immunodeficiency Virus (from the Veterans

Christopher J Berg1, Bobby Patel1, Maxwell Reynolds1

  • 1Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California; VA Greater Los Angeles Healthcare System, Los Angeles, California.

The American Journal of Cardiology
|November 7, 2022
PubMed

Insights

People living with HIV (PLWH) on antiretroviral therapy and with viral suppression showed no difference in cardiac mechanics or diastolic dysfunction compared to HIV-uninfected individuals.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Public Health

Background:

  • Human immunodeficiency virus (HIV) infection is linked to cardiovascular issues, including cardiomyopathy and increased cardiovascular mortality.
  • The impact of HIV on left atrial (LA) mechanics and left ventricular (LV) diastolic function remains under-evaluated, particularly in treated and virally suppressed populations.

Purpose of the Study:

  • To investigate the relationship between LA mechanics, LV diastolic function, and diastolic dysfunction in people living with HIV (PLWH) compared to HIV-uninfected (HIV-) controls.
  • To assess if HIV status influences cardiac function, specifically LA and LV mechanics, in a cohort of veterans without known cardiovascular disease.

Main Methods:

  • A multicenter, cross-sectional cohort analysis of the HIV Cardiovascular Disease substudy of the Veterans Aging Cohort Study database.
  • Echocardiograms from 277 subjects (180 PLWH, 97 HIV-) were analyzed to derive LV and LA phasic strain.
  • Analysis of variance and propensity-weighted ordinal logistic regression were used to assess relationships between LA strain, LV strain, and diastolic dysfunction.

Main Results:

  • No significant differences were observed in LA mechanics or the proportion of diastolic dysfunction between PLWH and HIV- veterans (p = 0.31).
  • HIV status was not associated with the degree of diastolic dysfunction after propensity weighting.
  • In both cohorts, LA reservoir strain and LA conduit strain were inversely and independently associated with the degree of diastolic dysfunction.

Conclusions:

  • Virally suppressed, antiretroviral-treated PLWH did not exhibit differences in LA strain or LV diastolic dysfunction compared to HIV- veterans.
  • HIV viral suppression may potentially mitigate adverse cardiac structural and functional alterations.
  • Further confirmation in diverse cohorts is warranted to solidify the role of viral suppression in cardiovascular health for PLWH.

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