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Bloomfield GS, Alenezi F, Chiswell K, Dunning A, Okeke NL, Velazquez EJ. Progression of cardiac structure and function in people with human immunodeficiency virus. Echocardiography 2022; 39:268-277. [PMID: 35048419 PMCID: PMC11196839 DOI: 10.1111/echo.15302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/13/2021] [Accepted: 01/04/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE People living with HIV (PLWH) are at increased risk for cardiac dysfunction. It is unknown how their global longitudinal cardiac function, cardiac structure, and other indices of function progress over time. We aimed to characterize the longitudinal trend in cardiac structure and function in PLWH. DESIGN Retrospective study of PLWH with clinically obtained echocardiograms at an academic medical center. METHODS We reviewed archived transthoracic echocardiograms (TTEs) performed between 2001 and 2012 on PLWH. The primary outcome measures were progression of global longitudinal strain (GLS, left and right ventricles), LV mass, E/e' ratio, LV end-systolic, and -diastolic volumes using hierarchical mixed model analysis as a function of CD4+ T cell count and HIV RNA suppression. Models were adjusted for clinical and demographic characteristics. RESULTS We analyzed 469 TTEs from 150 individuals (median age 46 years, 58% male). Median CD4+ T cell counts at nadir and proximal to first echocardiogram were 85 and 222 cells/mm3 , respectively. Over a median of 5 years, LV mass index increased regardless of nadir or proximal CD4+ T cell count or viral suppression status. PLWH with viral suppression at baseline had more normal GLS throughout the follow-up period. There were no significant trends in LV end-systolic volume index or E/e'. CONCLUSIONS In PLWH, HIV viral suppression is associated with early gains in echocardiographic indices of cardiac function that persist for up to >5 years. HIV disease control impacts routine echocardiographic measures with known impacts on long-term prognosis.
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Affiliation(s)
- Gerald S. Bloomfield
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Fawaz Alenezi
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Karen Chiswell
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Allison Dunning
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Nwora Lance Okeke
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Eric J. Velazquez
- Division of Cardiology, Yale University, New Haven, Connecticut, USA
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Morhy SS, Barberato SH, Lianza AC, Soares AM, Leal GN, Rivera IR, Barberato MFA, Guerra V, Ribeiro ZVDS, Pignatelli R, Rochitte CE, Vieira MLC. Position Statement on Indications for Echocardiography in Fetal and Pediatric Cardiology and Congenital Heart Disease of the Adult - 2020. Arq Bras Cardiol 2020; 115:987-1005. [PMID: 33295472 PMCID: PMC8452202 DOI: 10.36660/abc.20201122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | - Silvio Henrique Barberato
- Cardioeco - Centro de Diagnóstico Cardiovascular, Curitiba, PR - Brasil
- Quanta Diagnóstico e Terapia, Curitiba, PR - Brasil
| | - Alessandro Cavalcanti Lianza
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
- Instituto da Criança e do Adolescente do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP - Brasil
- Hospital do Coração, São Paulo, SP - Brasil
| | - Andressa Mussi Soares
- Hospital Evangélico de Cachoeiro de Itapemirim e Clínica CORImagem, Cachoeiro de Itapemirim, ES - Brasil
| | - Gabriela Nunes Leal
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
- Instituto da Criança e do Adolescente do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP - Brasil
- Hospital do Coração, São Paulo, SP - Brasil
- Hospital e Maternidade São Luiz Itaim, São Paulo, SP - Brasil
| | | | | | - Vitor Guerra
- The Hospital for Sick Children, Toronto - Canadá
| | | | - Ricardo Pignatelli
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas - EUA
| | - Carlos Eduardo Rochitte
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (InCor, FMUSP), São Paulo, SP - Brasil
| | - Marcelo Luiz Campos Vieira
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (InCor, FMUSP), São Paulo, SP - Brasil
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Abstract
OBJECTIVE To define the prevalence of early cardiac dysfunction in children and young adults with perinatally acquired HIV and predictors of cardiac function. DESIGN Cross-sectional design. METHODS Early cardiac dysfunction was defined as left ventricular (LV) global longitudinal strain z-score less than -2 or myocardial performance index at least 0.5 with normal LV ejection fraction. Regression models were fitted to assess the relationship between measures of cardiac function and HIV RNA levels, clinical variables, and markers of inflammation. RESULTS Six hundred and forty-three individuals (mean age 14.1 ± 5.2 years) were enrolled. The average time on combination antiretroviral treatment was 6.8 ± 3.6 years. Nearly 28% of individuals met criteria for early cardiac dysfunction. Individuals with early cardiac dysfunction were older (15.3 vs. 13.5 years, P < 0.001), had more frequently detectable HIV RNA (52.5 vs. 41.7%, P = 0.018), were more likely exposed to azidothymidine or zidovudine (ZDV) (55.6 vs. 41.2%, P = 0.002), and had higher median level of plasma IL-6 concentrations (1.00 vs. 0.88 pg/ml, P = 0.011). Multivariable models show LV ejection fraction negatively associated with HIV RNA levels [β -0.18; 95% confidence interval (CI) -0.33, -0.03] and ZDV exposure (β -1.75; 95% CI -2.62, -0.88) and positively associated with proportion of life on combination antiretroviral treatment (β 2.65; 95% CI 0.90, 4.41). Higher myocardial performance index was positively associated with serum inflammation marker (IL-6 β 0.01; 95% CI 0.0001, 0.001). Left ventricular global longitudinal strain was not significantly associated with clinical and laboratory variables of interest. CONCLUSION Over one-quarter of children and young adults living with HIV demonstrated evidence of cardiac dysfunction, which may be associated with increasing levels of systemic inflammation.
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Capotosto L, D'Ettorre G, Ajassa C, Cavallari N, Ciardi MR, Placanica G, Ricci S, Lucchetti P, Tanzilli G, Mangieri E, Gaudio C, Vullo V, Vitarelli A. Assessment of Biventricular Function by Three-Dimensional Speckle Tracking Echocardiography in Adolescents and Young Adults with Human Immunodeficiency Virus Infection: A Pilot Study. Cardiology 2019; 144:101-111. [PMID: 31614346 DOI: 10.1159/000503140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 09/03/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The purpose of the study was to assess biventricular parameters of wall deformation with three-dimensional speckle tracking echocardiography (3DSTE) in adolescents and young adults with human immunodeficiency virus (HIV) infection on antiretroviral therapy in order to detect a possible subclinical myocardial dysfunction. METHODS Twenty-one patients aged 12-39 years with HIV, 21 normal controls of the same age and sex, and 21 patients with idiopathic nonischemic dilated cardiomyopathy (DCM) were studied with 3DSTE. All HIV patients were stable in terms of HIV infection, with no history of heart disease or other chronic systemic disease except HIV infection, and were on highly active antiretroviral therapy with good immunological control. Standard echocardiographic measures of left ventricular (LV)-right ventricular (RV) function were assessed. 3D LV global longitudinal strain (GLS), circumferential strain, radial strain, and LV twist were calculated. Global area strain (GAS) was calculated by 3DSTE as percentage variation in surface area defined by the longitudinal and circumferential strain vectors. 3D RV global and free-wall longitudinal strain (FWLS) were obtained. RESULTS LV GLS and GAS were lower in HIV patients compared to normal controls (p = 0.002, and p = 0.01, respectively). There were no significant differences in LV ejection fractions between the groups. There was a weak positive correlation between LV GLS and age (r = 0.215, p = 0.034) and a weak negative correlation between LV GLS and nadir-CD4 T-cells count (r = 0.198, p = 0.043). DCM patients had more marked and widespread reduction in LV GLS and GAS compared to controls (p < 0.001), whereas in HIV patients LV strain impairment (p < 0.05) was more localized in basal and apical regions. RV FWLS was significantly reduced in HIV patients when compared with the control group (p = 0.03). No patient had pulmonary systolic pressure higher than 35 mm Hg. CONCLUSIONS 3DSTE may help to identify HIV patients at high cardiovascular risk allowing early detection of biventricular dysfunction in the presence of normal LV ejection fraction and in the absence of pulmonary hypertension. LV strain impairment in HIV patients is less prominent and widespread compared to DCM patients.
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Affiliation(s)
| | | | - Camilla Ajassa
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | - Nelson Cavallari
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | | | | | - Serafino Ricci
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | - Pietro Lucchetti
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | | | | | - Carlo Gaudio
- Department of Cardiology, Sapienza University, Rome, Italy
| | - Vincenzo Vullo
- Department of Infectious Diseases, Sapienza University, Rome, Italy
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HIV-infected Children in Malawi Have Decreased Performance on the 6-minute Walk Test With Preserved Cardiac Mechanics Regardless of Antiretroviral Treatment Status. Pediatr Infect Dis J 2017; 36:659-664. [PMID: 28060042 PMCID: PMC6899075 DOI: 10.1097/inf.0000000000001540] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AIM The aims of this study were to 1) determine if cardiac disease can be detected in HIV-infected children by strain imaging and 2) to evaluate differences in exercise performance between HIV-infected children on antiretroviral therapy (ART) and HIV-infected children not yet on ART and in HIV-uninfected children by 6-minute walk tests (6MWTs). METHODS This cross-sectional study evaluated cardiac function by echocardiogram and exercise performance by 6MWT in HIV-infected and HIV-uninfected children 4-18 years of age in Lilongwe, Malawi. Analyses compared HIV uninfected, HIV infected not yet on ART, and HIV infected on ART. Comparisons used χ(2) test, t test, analysis of variance and multiple linear regression. RESULTS No differences were found in ejection fraction, shortening fraction or strain in 73 children not yet on ART, 149 on ART and 77 HIV-uninfected controls. As viral load increased, children had worse circumferential strain. In addition, children receiving ART had better circumferential strain than those not yet on ART. Increased CD4 percentage was associated with better longitudinal strain and farther 6MWT distance. As longitudinal strain worsened, the 6MWT distance decreased. HIV-infected children not yet on ART walked a mean of 25.8 m less than HIV-uninfected children, and HIV-infected children on ART walked 25.9 m less (P = 0.015 comparing 3 groups). CONCLUSIONS HIV-uninfected children performed better on the 6MWT than HIV-infected children. Lower viral load, being on ART, and higher CD4 percentage were associated with better strain measures. Better longitudinal strain was associated with a farther 6MWT distance. Overall, ejection fraction, shortening fraction and strain measures between groups were similar, so cardiac strain did not detect cardiac dysfunction in this young population.
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Ryscavage P, Macharia T, Trinidad LR, Lovelace S, Tepper V, Redfield R. Patterns of Systemic Hypertension among Adults with Perinatally Acquired HIV. J Int Assoc Provid AIDS Care 2016; 16:3-7. [PMID: 27644759 DOI: 10.1177/2325957416668034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Patients with perinatally acquired HIV may be at risk for the development of age-related non-AIDS diseases. The primary aim of this study was to describe patterns of systemic hypertension among a cohort of adults (≥18 years) with perinatally acquired HIV. A retrospective cohort study was conducted among adults (≥18 years) with perinatally acquired HIV infection. Primary outcomes included documentation of systemic hypertension as well as several additional non-AIDS-associated illnesses. Systemic hypertension incidence rates and rate ratios (RRs) were calculated among groups aged ≥18 and <18 years at the time of hypertension diagnosis. The overall prevalence of hypertension in the cohort (N = 109) was 26.6%, and the incidence rate of hypertension was significantly higher among those aged ≥18 years compared to those who are aged <18 years at the time of diagnosis (RR: 10.0, CI: 7.29-13.71). By multivariable analysis, only coexisting renal disease was associated with an increased risk of hypertension diagnosis.
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Affiliation(s)
- Patrick Ryscavage
- 1 Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Thomas Macharia
- 1 Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lino R Trinidad
- 1 Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Susan Lovelace
- 2 Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vicki Tepper
- 2 Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Robert Redfield
- 1 Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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Bloomfield GS, Alenezi F, Barasa FA, Lumsden R, Mayosi BM, Velazquez EJ. Human Immunodeficiency Virus and Heart Failure in Low- and Middle-Income Countries. JACC-HEART FAILURE 2016; 3:579-90. [PMID: 26251085 DOI: 10.1016/j.jchf.2015.05.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/29/2015] [Accepted: 05/01/2015] [Indexed: 12/11/2022]
Abstract
Successful combination therapy for human immunodeficiency virus (HIV) has transformed this disease from a short-lived infection with high mortality to a chronic disease associated with increasing life expectancy. This is true for high- as well as low- and middle-income countries. As a result of this increased life expectancy, people living with HIV are now at risk of developing other chronic diseases associated with aging. Heart failure has been common among people living with HIV in the eras of pre- and post- availability of antiretroviral therapy; however, our current understanding of the pathogenesis and approaches to management have not been systematically addressed. HIV may cause heart failure through direct (e.g., viral replication, mitochondrial dysfunction, cardiac autoimmunity, autonomic dysfunction) and indirect (e.g., opportunistic infections, antiretroviral therapy, alcohol abuse, micronutrient deficiency, tobacco use) pathways. In low- and middle-income countries, 2 large observational studies have recently reported clinical characteristics and outcomes in these patients. HIV-associated heart failure remains a common cardiac diagnosis in people living with heart failure, yet a unifying set of diagnostic criteria is lacking. Treatment patterns for heart failure fall short of society guidelines. Although there may be promise in cardiac glycosides for treating heart failure in people living with HIV, clinical studies are needed to validate in vitro findings. Owing to the burden of HIV in low- and middle-income countries and the concurrent rise of traditional cardiovascular risk factors, strategic and concerted efforts in this area are likely to impact the care of people living with HIV around the globe.
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Affiliation(s)
- Gerald S Bloomfield
- Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Duke University Medical Center, Durham, North Carolina.
| | - Fawaz Alenezi
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Felix A Barasa
- Division of Medicine, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Rebecca Lumsden
- School of Medicine, University of Massachusetts, Worcester, Massachusetts
| | - Bongani M Mayosi
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Eric J Velazquez
- Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Duke University Medical Center, Durham, North Carolina
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Idris NS, Grobbee DE, Burgner D, Cheung MMH, Kurniati N, Sastroasmoro S, Uiterwaal CSPM. Cardiovascular manifestations of HIV infection in children. Eur J Prev Cardiol 2014; 22:1452-61. [PMID: 25398702 DOI: 10.1177/2047487314560086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 10/28/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND HIV infection in children is now considered as a chronic condition, in which various non-infectious complications may occur, including those affecting the developing cardiovascular system. As children are expected to survive well into adulthood, understanding childhood as well as potential future cardiovascular complications is of major importance. METHODS AND RESULTS We reviewed published literature on childhood cardiac manifestations and longer term effects of pediatric HIV infection on the cardiovascular system. Evidence gaps that should be prioritized in research are highlighted. Through poorly understood mechanisms, HIV infection may cause various cardiac complications already manifesting in childhood, such as structural and functional myocardial derangements, pulmonary hypertension, pericardial effusion and possibly endocarditis. Evidence indicates that HIV infection in children also has unfavorable effects on the vasculature and cardiovascular biomarkers, such as increased intima-media thickness and decreased flow-mediated dilation, a marker of endothelial function. However, studies are small and predominantly include antiretroviral therapy-treated children, so that it is difficult to differentiate between effects of HIV infection per se and antiretroviral therapy treatment, reported in adults to have cardiovascular side effects. CONCLUSIONS HIV infection in children may greatly impact the cardiovascular system, including effects on the heart, which tend to manifest early in childhood, and on the vasculature. The underlying mechanisms, essential for targeted prevention, are poorly understood. Current evidence largely stems from research in adults. However, as modes of infection, immune maturity, growth and development, and treatment are markedly different in children, specific pediatric research, accounting for the complex interplay of normal growth and development, HIV infection and treatment, is clearly warranted.
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Affiliation(s)
- Nikmah S Idris
- Department of Child Health/Centre for Clinical Epidemiology and Evidence Based Medicine (CEEBM), Faculty of Medicine University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia Julius Global Health, Julius Center for Health Science and Primary Care, The University Medical Center, Utrecht, The Netherlands Department of Pediatrics, University of Melbourne, Australia Murdoch Children Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Science and Primary Care, The University Medical Center, Utrecht, The Netherlands
| | - David Burgner
- Department of Pediatrics, University of Melbourne, Australia Murdoch Children Research Institute, Royal Children's Hospital, Melbourne, Australia Department of Paediatrics, Monash University, Australia
| | - Michael M H Cheung
- Department of Pediatrics, University of Melbourne, Australia Murdoch Children Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Nia Kurniati
- Department of Child Health/Centre for Clinical Epidemiology and Evidence Based Medicine (CEEBM), Faculty of Medicine University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Sudigdo Sastroasmoro
- Department of Child Health/Centre for Clinical Epidemiology and Evidence Based Medicine (CEEBM), Faculty of Medicine University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Cuno S P M Uiterwaal
- Julius Global Health, Julius Center for Health Science and Primary Care, The University Medical Center, Utrecht, The Netherlands
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