Association Between HIV Infection Duration and Left Ventricular Concentric Remodeling and Myocardial Fibrosis: A...

Antiretroviral therapy has transformed HIV into a chronic condition, yet cardiac injury remains a major issue.

To assess the ability of cardiac MR imaging markers to predict cardiac injury and disease progression in HIV-infected individuals.

Prospective.

Eighty-three HIV-infected participants (short-duration infection < 5 years, n = 43; long-duration ≥ 5 years, n = 40) and 34 matched HIV-negative controls.

1.5 T; SSFP cine and MOLLI sequences.

Left ventricular (LV) end diastolic volume indexed to body surface area (LVEDVi), ejection fraction (LVEF), mass (LVM), myocardial mass-to-volume ratio (MVR), and global strains were determined from SSFP cine data. Extracellular volume (ECV) and myocardial extracellular matrix volume index (ECMVi) were determined from pre- and post-contrast myocardial T1 values.

ANOVA, Kruskal-Wallis, post hoc tests, correlation, and multivariable logistic regression; p < 0.05 indicated statistical significance.

Both the HIV groups showed significantly elevated ECV (short: median 28.02 [25.40-31.86]%; long: median 28.18 [24.40-37.99]% vs. 25.07% ± 5.61%) and myocardial native T1 (1863.35 ± 300.29 ms; median 1963.00 [1807.00, 2072.25] ms vs. median 1734 [1309.75-1981.50] ms) compared to controls. The long-duration group exhibited significantly higher ECMVi (14.73 ± 4.59 mL/m² vs. controls: 10.52 ± 2.82 mL/m² and short: 12.32 ± 2.83 mL/m²) and MVR (0.78 ± 0.16 vs. 0.61 ± 0.11 g/mL and median 0.63 [0.55-0.69] g/mL), significantly reduced LVEDVi (65.44 ± 13.21 vs. 73.42 ± 10.99 and 72.08 ± 10.62 mL/m²) and significantly diminished global radial strain (29.82% ± 6.28% vs. controls: 36.18% ± 6.39% and short: median 33.16 [28.44-37.52]%).HIV duration correlated positively with ECMVi and MVR (r = 0.277 and 0.474, respectively), and significantly negatively correlated with global radial strain (r = -0.244). Two robust MRI models were validated: ECV/native T1/fasting blood glucose (FBG) for early HIV (AUC = 0.852) and LVEDVi/ECMVi/FBG for duration stratification (AUC = 0.844), with stable performance through bootstrapping and calibration.

ECV, myocardial native T1, and FBG can predict short-duration HIV infection, while a multimodal model (LVEDVi, ECMVi, and FBG)stratifies duration. However, prospective validation is necessary.

2.

Stage 3.