Myocardial deformation imaging unmasks subtle left ventricular systolic dysfunction in asymptomatic and treatment-naïve HIV patients

• Published in: Clinical research in cardiology Vol. 104; no. 11; pp. 975 - 981
• Main Authors: Karavidas, Apostolos, Xylomenos, George, Matzaraki, Vassiliki, Papoutsidakis, Nikolaos, Leventopoulos, Georgios, Farmakis, Dimitrios, Lazaros, George, Perpinia, Anastasia, Arapi, Sophia, Paisios, Nikolaos, Parissis, John, Pyrgakis, Vlasios, Gargalianos, Panagiotis
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2015; Springer Nature B.V
• Subjects: Adult; Cardiology; Diagnosis, Differential; Elastic Modulus; Elasticity Imaging Techniques - methods; Female; HIV Infections - complications; HIV Infections - diagnostic imaging; HIV Infections - physiopathology; Human immunodeficiency virus; Humans; Image Interpretation, Computer-Assisted - methods; Male; Medicine; Medicine & Public Health; Original Paper; Reproducibility of Results; Sensitivity and Specificity; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - physiopathology; Myocardial deformation; HIV; Systolic dysfunction; Strain; Strain rate
• ISSN: 1861-0684; 1861-0692; 1861-0692
• DOI: 10.1007/s00392-015-0866-8

Background Patients infected by the human immunodeficiency virus (HIV) and receiving highly active antiretroviral therapy have a higher incidence of cardiovascular disease than healthy subjects, but little is known about cardiac function in asymptomatic and treatment-naïve patients. We sought to study cardiac function in asymptomatic HIV-infected, treatment-naïve patients. Methods We studied 41 HIV-infected and treatment-naïve patients and 20 age- and sex-matched healthy controls. Patients with cardiac symptoms, history of cardiac disease or NT-proBNP >100 pg/mL were excluded. We addressed cardiac function using standard echocardiography along with tissue Doppler (TDI) measurements, including strain/strain rate assessment. Results Standard echocardiographic parameters did not differ between groups, except for transmitral E wave velocity (64.8 ± 14 cm/s in HIV vs 76.1 ± 10 cm/s in controls, p  = 0.002). In contrast, TDI mitral and tricuspid annulus s velocity and all strain/strain rate measurements were significantly lower in HIV patients: s lateral, 10.2 ± 2.4/11.3 ± 0.7, p  = 0.011; s septal, 8.1 ± 1.6/8.7 ± 0.8, p  = 0.045; s tricuspid, 13.4 ± 2.3/14.9 ± 1.3, p  = 0.002; strain/strain rate, septal (strain/strain rate, 15.1 ± 5.7/−0.9 ± 0.3, 25.3 ± 1.7/−1.9 ± 0.2, p  < 0.001), anterior (16.7 ± 3/−1.0 ± 0.1, 26.7 ± 1.7/−1.9 ± 0.2, p  < 0.001), lateral (16.0 ± 6/−1.0 ± 0.1, 27.5 ± 1.8/−2.2 ± 0.3, p  < 0.001) and posterior (15.2 ± 5.8/−1.0 ± 0.2, 26.2 ± 1.8/−2.2 ± 0.3, p  < 0.001) left ventricular wall. Conclusions HIV infection itself is accompanied by subclinical systolic dysfunction, not apparent to standard echocardiography that can be unmasked though using sensitive echocardiographic techniques.