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Predictors of myocardial dysfunction in human immunodeficiency virus-infected patients
J Silva-Cardoso1, B Moura, A Ferreira
1Porto Cardiovascular Research, Porto Medical School, Hospital de S. João, Portugal.
Insights
Pulmonary infections may cause right ventricular dysfunction in human immunodeficiency virus (HIV) patients. Aggressive treatment of infections could prevent heart failure in those with HIV.
Area of Science:
- Cardiology
- Infectious Diseases
- Pulmonology
Background:
- Heart involvement, including ventricular dysfunction, is common in human immunodeficiency virus (HIV) infection.
- The underlying causes of cardiac manifestations in HIV remain unclear.
- Right and left ventricular dysfunction are frequent complications observed in HIV patients.
Purpose of the Study:
- To identify clinical predictors of right and left ventricular dysfunction in patients with HIV.
- To elucidate the pathogenesis of ventricular dysfunction in the context of HIV infection.
- To assess the association between clinical variables and cardiac abnormalities in HIV.
Main Methods:
- Prospective clinical and echocardiographic study of 181 patients with HIV.
- Utilized backward logistic regression to identify independent predictors of ventricular dysfunction.
- Analyzed clinical variables including pulmonary infections and history of opportunistic infections.
Main Results:
- Pulmonary infections were the sole independent predictor of isolated right ventricular dysfunction (OR=4.08, P=.02).
- Pulmonary arterial hypertension signs were present in 71% of patients with right ventricular dilation.
- History of opportunistic infections (OR=10.9, P=.0026) and advanced AIDS (>12 months, OR=6.6, P=.03) predicted left ventricular dysfunction.
Conclusions:
- Right ventricular dysfunction in HIV may stem from pulmonary hypertension due to recurrent pulmonary infections, not primary heart disease.
- Opportunistic infections are linked to left ventricular dysfunction in HIV.
- Proactive management of opportunistic infections may be crucial for preventing heart failure in HIV patients.
Background:
Some of the most frequent manifestations of heart involvement in human immunodeficiency virus (HIV) infection include right and left ventricular dysfunction. The pathogenesis remains obscure.
Methods And Results:
This prospective clinical and echocardiographic study involved 181 patients at all stages of HIV infection. We tested a set of clinical variables using a backward logistic regression model to assess their ability to independently predict the presence of ventricular dysfunction. The presence of pulmonary infections (all etiologies mixed) was the only variable independently associated with isolated right ventricular dysfunction (odds ratio = 4.08; P = .02). Signs suggestive of pulmonary arterial hypertension were present in 71% of the patients with right ventricular dilation. History of previous opportunistic infections (all etiologies mixed) (odds ratio = 10.9; P = .0026) and time since the diagnosis of acquired immunodeficiency syndrome more than 12 months (odds ratio = 6.6; P = .03) were the only two independent predictors of left ventricular dysfunction.
Conclusions:
Isolated right ventricular dysfunction may be secondary to pulmonary hypertension caused by repetitive pulmonary infections and not to primary myocardial disease. The aggressive treatment of opportunistic infections may become an important element of heart failure prophylaxis in HIV infection because they may be associated with left ventricular dysfunction.