1
|
Barros K, Tepper JW, Ramchandani J, Kelley MK, Kussin ML, Israel EN, Tompkins MG, Alali M. Unusual presentation of disseminated cryptococcal infection complicated by myocarditis in a heart transplant recipient. Pediatr Transplant 2024; 28:e14585. [PMID: 37489596 DOI: 10.1111/petr.14585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 06/21/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Cryptococcus neoformans is the third most common cause of invasive fungal infection in solid organ transplant (SOT) recipients. While cryptococcal infection can involve any organ, cases of myocarditis are exceedingly rare. METHODS A retrospective chart review was completed for this case report. RESULTS We present the case of a 21-year-old heart transplant recipient who developed disseminated cryptococcal infection with biopsy-proven cryptococcal myocarditis. CONCLUSIONS Cryptococcal disease in SOT recipients poses diagnostic and therapeutic challenges. There are no current guidelines for the duration of cryptococcal myocarditis treatment. Repeat myocardial biopsy may play a role in guiding length of therapy.
Collapse
Affiliation(s)
- Kathryn Barros
- Ryan White Center for Pediatric Infectious Diseases & Global Health, Indiana University, Indianapolis, Indiana, USA
| | - John William Tepper
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Juhi Ramchandani
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Meagan Kristine Kelley
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michelle L Kussin
- Pediatric Infectious Diseases, Department of Pharmacy, Riley Hospital for Children at Indiana University Health and Ryan White Center for Pediatric Infectious Diseases & Global Health, Indiana University, Indianapolis, Indiana, USA
| | - Emily N Israel
- Purdue College of Pharmacy, West Lafayette, Indiana, USA
- Department of Pharmacy, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Madeline G Tompkins
- Pediatric Cardiology, Department of Pharmacy, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Muayad Alali
- Ryan White Center for Pediatric Infectious Diseases & Global Health, Indiana University, Indianapolis, Indiana, USA
| |
Collapse
|
2
|
Kumar P, Arendt C, Martin S, Al Soufi S, DeLeuw P, Nagel E, Puntmann VO. Multimodality Imaging in HIV-Associated Cardiovascular Complications: A Comprehensive Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2201. [PMID: 36767567 PMCID: PMC9915416 DOI: 10.3390/ijerph20032201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
Human immunodeficiency virus (HIV) infection is a leading cause of mortality and morbidity worldwide. The introduction of antiretroviral therapy (ART) has significantly reduced the risk of developing acquired immune deficiency syndrome and increased life expectancy, approaching that of the general population. However, people living with HIV have a substantially increased risk of cardiovascular diseases despite long-term viral suppression using ART. HIV-associated cardiovascular complications encompass a broad spectrum of diseases that involve the myocardium, pericardium, coronary arteries, valves, and systemic and pulmonary vasculature. Traditional risk stratification tools do not accurately predict cardiovascular risk in this population. Multimodality imaging plays an essential role in the evaluation of various HIV-related cardiovascular complications. Here, we emphasize the role of multimodality imaging in establishing the diagnosis and aetiopathogenesis of various cardiovascular manifestations related to chronic HIV disease. This review also provides a critical appraisal of contemporary data and illustrative cases.
Collapse
Affiliation(s)
- Parveen Kumar
- Institute of Experimental and Translational Cardiac Imaging, DZHK, Centre for Cardiovascular Imaging, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
| | - Christophe Arendt
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
| | - Simon Martin
- Institute of Experimental and Translational Cardiac Imaging, DZHK, Centre for Cardiovascular Imaging, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
| | - Safaa Al Soufi
- Institute of Experimental and Translational Cardiac Imaging, DZHK, Centre for Cardiovascular Imaging, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
| | | | - Eike Nagel
- Institute of Experimental and Translational Cardiac Imaging, DZHK, Centre for Cardiovascular Imaging, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
| | - Valentina O. Puntmann
- Institute of Experimental and Translational Cardiac Imaging, DZHK, Centre for Cardiovascular Imaging, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
| |
Collapse
|
3
|
Clinical Application of Cardiac Magnetic Resonance in ART-Treated AIDS Males with Short Disease Duration. Diagnostics (Basel) 2022; 12:diagnostics12102417. [PMID: 36292106 PMCID: PMC9601106 DOI: 10.3390/diagnostics12102417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/21/2022] [Accepted: 10/04/2022] [Indexed: 11/25/2022] Open
Abstract
Cardiac complications are common in antiretroviral therapy-treated (ART-treated) acquired immune deficiency syndrome (AIDS) patients, and the incidence increases with age. Myocardial injury in ART-treated AIDS patients with a relatively longer disease duration has been evaluated. However, there is no relevant study on whether patients with a short AIDS duration have cardiac dysfunction. Thirty-seven ART-treated males with AIDS and eighteen healthy controls (HCs) were prospectively included for CMR scanning. Clinical data and laboratory examination results were collected. The ART-treated males with AIDS did not have significantly reduced biventricular ejection fraction, myocardial edema, or late gadolinium enhancement. Compared with the HCs, the biventricular volume parameters and left ventricle myocardial strain indices in ART-treated males with AIDS were not significantly reduced (all p > 0.05). ART-treated males with AIDS were divided into subgroups according to their CD4+ T-cell counts (<350 cells/μL and ≥350 cells/μL) and duration of disease (1−12 months, 13−24 months, and 25−36 months). There was no significant decrease in left or right ventricular volume parameters or myocardial strain indices among the subgroups (all p > 0.05). In Pearson correlation analysis, CD4+ T-cell counts were not significantly correlated with biventricular volume parameters or left ventricular myocardial strain indices. In conclusion, ART-treated males with AIDS receiving ART therapy with a short disease duration (less than 3 years) might not develop obvious cardiac dysfunction as evaluated by routine CMR, so it is reasonable to appropriately extend the interval between cardiovascular follow-ups to more than 3 years.
Collapse
|
4
|
Remick J, Georgiopoulou V, Marti C, Ofotokun I, Kalogeropoulos A, Lewis W, Butler J. Heart failure in patients with human immunodeficiency virus infection: epidemiology, pathophysiology, treatment, and future research. Circulation 2014; 129:1781-9. [PMID: 24778120 DOI: 10.1161/circulationaha.113.004574] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Joshua Remick
- Division of Cardiovascular Medicine (J.R., V.G., C.M., A.K., J.B.), Division of Infectious Diseases (I.O.), and Department of Pathology (W.L.), Emory University, Atlanta, GA
| | | | | | | | | | | | | |
Collapse
|
5
|
Abstract
The lifespan of HIV-infected patients is increasing, and cardiovascular diseases becoming a major comorbidity and leading cause of death in this population due to high prevalence of the cardiac risk factors and possibly due to the use of antiretroviral therapy. Aggressive reduction of these risk factors and treatment of cardiovascular diseases are crucial to decrease the cardiovascular mortality in these patients.
Collapse
|
6
|
Jain N, Reddy DH, Verma SP, Khanna R, Vaish AK, Usman K, Tripathi AK, Singh A, Mehrotra S, Gupta A. Cardiac abnormalities in HIV-positive patients: results from an observational study in India. J Int Assoc Provid AIDS Care 2012; 13:40-6. [PMID: 22968352 DOI: 10.1177/1545109712456740] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The clinical presentation of cardiac abnormalities in HIV-infected patients may be atypical or masked by concurrent illnesses that lead to misdiagnosis or they remain undiagnosed; therefore, this study was aimed to determine the frequency of cardiac abnormalities in HIV-infected patients. MATERIAL AND METHODS Consecutive HIV-infected patients of age >13 years were studied for 3 months, after obtaining their consent. After clinical assessment, chest x-ray, electrocardiogram, 2-dimensional echocardiography and serum Troponin T levels were done. RESULTS A total of 100 patients were studied, cardiomegaly was observed in the x-ray of 15% of them, abnormal electrocardiogram was seen in 18%, 2-dimensional echocardiography was abnormal in 67%; and diastolic dysfunction (42.8%) was the commonest abnormality followed by dilated cardiomyopathy (17.6%). Serum troponin T was elevated in 8%. The variables, opportunistic infections (OIs), antiretroviral therapy (ART), stage of HIV disease, and CD4 counts, did not affect the frequency of diastolic dysfunction. CONCLUSION The diastolic dysfunction is the most common cardiac abnormality observed in HIV-infected patients.
Collapse
Affiliation(s)
- Nirdesh Jain
- Department of Internal Medicine, Chhatrapati Shahuji Maharaj Medical University, Lucknow, India
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Fares S, Irfan FB. Thoracic Emergencies in Immunocompromised Patients. Emerg Med Clin North Am 2012; 30:565-89, x. [DOI: 10.1016/j.emc.2011.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
8
|
Kenyon C, Schrueder N, Ntsekhe M, Meintjes G. Heart failure and cardiogenic shock associated with the TB-immune reconstitution inflammatory syndrome. Cardiovasc J Afr 2012; 23:e14-7. [PMID: 22555754 PMCID: PMC4728260 DOI: 10.5830/cvja-2011-062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Accepted: 09/11/2011] [Indexed: 12/05/2022] Open
Abstract
Heart failure has not been described in the setting of TB-immune reconstitution inflammatory syndrome (IRIS). We describe a case of cardiogenic shock in the setting of TB-IRIS four weeks after commencement of antiretroviral therapy. Possible aetiologies and pathophysiology as well as suggested diagnostic and therapeutic approaches to this problem are discussed.
Collapse
Affiliation(s)
- Chris Kenyon
- Department of Medicine, GF Jooste Hospital, Cape Town, South Africa.
| | | | | | | |
Collapse
|
9
|
Chillo P, Bakari M, Lwakatare J. Echocardiographic diagnoses in HIV-infected patients presenting with cardiac symptoms at Muhimbili National Hospital in Dar es Salaam, Tanzania. Cardiovasc J Afr 2012; 23:90-7. [PMID: 22331234 PMCID: PMC3721886 DOI: 10.5830/cvja-2011-060] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 09/21/2011] [Indexed: 01/20/2023] Open
Abstract
Objective To determine the pattern of echocardiographic diagnoses in HIV-infected patients presenting with cardiac symptoms at Muhimbili National Hospital in Dar es Salaam, Tanzania. Methods Patients known to be HIV positive and with cardiac complaints were prospectively recruited from the Hospital’s care and treatment centre as well as from the medical wards. Clinical assessment, laboratory tests and echocardiography were performed. Results A total of 102 patients were recruited from September 2009 to April 2010. The patients’ mean age was 42.4 years and 68.6% were women. The most common diagnosis was pericardial effusion present in 41.2% of the patients. The effusion was large in 5.9% and small in 35.3% of the patients. Hypertensive heart disease was diagnosed in 34.3%, while pulmonary hypertension and dilated cardiomyopathy were present in 12.7 and 9.8%, respectively. Conclusion Cardiac abnormalities are common in HIV-infected patients, particularly when they present with symptoms.
Collapse
Affiliation(s)
- Pilly Chillo
- Muhimbili National Hospital, Dar es Salaam, Tanzania.
| | | | | |
Collapse
|
10
|
Okoromah CAN, Ojo OO, Ogunkunle OO. Cardiovascular dysfunction in HIV-infected children in a sub-Saharan African country: comparative cross-sectional observational study. J Trop Pediatr 2012; 58:3-11. [PMID: 21292742 DOI: 10.1093/tropej/fmr009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Cardiac dysfunction is rarely diagnosed in HIV-infected children in our setting and standard care does not include baseline and follow-up echocardiography. We aimed to determine the prevalence, pattern and predictors of HIV-related cardiac dysfunction. METHODS Pre-diagnosed HIV-infected children aged 18 months to 12 years from a tertiary teaching hospital in Lagos, South-West Nigeria were enrolled in a comparative, observational cross-sectional study; matched with apparently healthy controls of the same age group, were recruited sequentially between May 2004 and 2007. Proportions of pre-defined cardiac abnormalities such as heart failure diagnosed by clinical examination and dilated cardiomyopathy and ventricular dysfunction by echocardiography were determined. RESULTS Prevalence of cardiac abnormalities in HIV-infected children was 75.9%. Abnormalities included heart failure, dilated cardiomyopathy (33.7%), decreased LVSF of ≤ 25% in 33.7%, increased left ventricular mass (20.5%) and pericardial effusion (14.5%). CONCLUSION Structural and functional abnormalities are prevalent in HIV-infected African children and therefore justify inclusion of routine echocardiography in their standard care.
Collapse
Affiliation(s)
- C A N Okoromah
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria.
| | | | | |
Collapse
|
11
|
Mitiku TY, Heidenreich PA. A small pericardial effusion is a marker of increased mortality. Am Heart J 2011; 161:152-7. [PMID: 21167348 DOI: 10.1016/j.ahj.2010.10.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 10/04/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE the study aimed to evaluate the prognostic importance of an incidental small pericardial effusion found on echocardiography. METHODS we identified 10,067 consecutive patients undergoing echocardiography at 1 of 3 laboratories. Patients were excluded if they were referred for evaluation of the pericardium (n = 133), had cardiac surgery within the previous 60 days (n = 393), had a moderate or greater pericardial effusion (>1 cm if circumferential, n = 29), had no follow-up (n = 153), or had inadequate visualization of the pericardial space (n = 9). The Social Security Death Index was used to determine survival. RESULTS a small pericardial effusion was noted in 534 (5.7%) of 9,350 patients. Compared to patients without a small effusion, those with an effusion were slightly older (68 ± 13 vs 67 ± 12 years, P = .02) and had a lower ejection fraction (52% vs 55%, P < .0001). Mortality at 1 year was greater for patients with a small effusion (26%) compared to those without an effusion (11%, P < .0001). After adjustment for demographics, medical history, patient location, and other echocardiographic findings, small pericardial effusion remained associated with higher mortality (hazard ratio 1.17, 95% CI 1.09-1.28, P = .0002). Of 211 with an effusion and follow-up echocardiography (mean 547 days), 136 (60%) had resolution, 63 (28%) showed no change, and 12 (5%) had an increase in size, although no patient developed a large effusion or cardiac tamponade. CONCLUSION the presence of a small asymptomatic pericardial effusion is associated with increased mortality.
Collapse
Affiliation(s)
- Teferi Y Mitiku
- Yale University School of Medicine, Department of Internal Medicine, Section of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | | |
Collapse
|
12
|
Sani MU. Myocardial disease in human immunodeficiency virus (HIV) infection: a review. Wien Klin Wochenschr 2008; 120:77-87. [PMID: 18322768 DOI: 10.1007/s00508-008-0935-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 12/28/2007] [Indexed: 10/22/2022]
Abstract
Heart muscle disease is the most important cardiovascular manifestation of HIV infection and is likely to become even more prevalent as HIV infected patients live longer. This may present as myocarditis, dilated cardiomyopathy or isolated left or right ventricular dysfunction. Myocardial involvement in HIV infection is multifactorial and may arise as a result of myocardial invasion with HIV itself, opportunistic infections, viral infections, autoimmune response to viral infection, drug-related cardiac toxicity, nutritional deficiencies, and prolonged immunosuppression. Both adults and children are affected with severity ranging from incidental microscopic inflammatory findings at autopsy to clinically significant cardiac disease with chronic cardiac dysfunction. It is associated with a poor prognosis, and results in symptomatic heart failure in up to 5% of HIV patients. Clinical pathological studies from the pre-HAART era show a 30% prevalence of cardiomyopathy in patients with AIDS. The introduction of highly active antiretroviral therapy (HAART) regimens has substantially modified the course of HIV disease by lengthening survival and improving quality of life of HIV-infected patients. There is also good evidence that HAART significantly reduces the incidence of cardiovascular manifestations of HIV infection. By preventing opportunistic infections and reducing the incidence of myocarditis, HAART regimens have reduced the prevalence of HIV-associated cardiomyopathy by almost 7-fold from the pre-HAART era. HAART is however only available to a minority of HIV infected individuals in most areas of the world and studies from the pre-HAART period still apply. In this review, the aetiopathogenesis and presentation of HIV related myocardial disease were reviewed and measures taken to improve survival discussed.
Collapse
|
13
|
Kristoffersen US, Lebech AM, Gerstoft J, Hesse B, Petersen CL, Gutte H, Kjær A. Right and left cardiac function in HIV-infected patients investigated using radionuclide ventriculography and brain natriuretic peptide: a 5-year follow-up study. HIV Med 2008; 9:180-6. [DOI: 10.1111/j.1468-1293.2007.00531.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
14
|
Montero M, Cercós A, Navarro V, Santos M. [Mycobacterium avium intracellulare pericarditis in patients with AIDS. A case report and literature review]. Enferm Infecc Microbiol Clin 2007; 25:606-7. [PMID: 17953906 DOI: 10.1157/13111193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
15
|
Cardiovascular Involvement in Acquired Immune Deficiency Syndrome. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
16
|
Stainback RF, Hamirani YS, Cooley DA, Buja LM. Tumors of the Heart. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
|
17
|
Restrepo CS, Martínez S, Lemos JA, Carrillo JA, Lemos DF, Ojeda P, Koshy P. Imaging Manifestations of Kaposi Sarcoma. Radiographics 2006; 26:1169-85. [PMID: 16844940 DOI: 10.1148/rg.264055129] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Kaposi sarcoma (KS) is a low-grade vascular tumor that typically manifests as one of four variants: classic KS, endemic (African) KS, iatrogenic (organ transplant-related) KS, or acquired immunodeficiency syndrome (AIDS)-related KS. Several clinical and epidemiologic differences have been noted among these variants. Classic KS and endemic KS rarely require radiologic evaluation due to their usually chronic course and stability of skin compromise. However, iatrogenic KS and AIDS-related KS, the most common forms of the disease, are frequently disseminated or symptomatic and may thus require imaging studies for both diagnosis and staging. KS is the most common tumor among AIDS patients, affecting a high percentage of these individuals, and is considered to be an AIDS-defining illness. Multiple organs can be involved by AIDS-related KS. KS has been linked with human herpes virus type 8 infection and other cofactors. Although pulmonary, gastrointestinal, and skin involvement by KS has previously been described, this tumor can affect multiple organs, generating a wide spectrum of imaging findings and pathologic correlates. It is important for the radiologist to be familiar with this spectrum of imaging manifestations and corresponding pathologic findings.
Collapse
Affiliation(s)
- Carlos S Restrepo
- Department of Radiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
| | | | | | | | | | | | | |
Collapse
|
18
|
Restrepo CS, Diethelm L, Lemos JA, Velásquez E, Ovella TA, Martinez S, Carrillo J, Lemos DF. Cardiovascular complications of human immunodeficiency virus infection. Radiographics 2006; 26:213-31. [PMID: 16418253 DOI: 10.1148/rg.261055058] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The heart and great vessels are not the sites most frequently affected by opportunistic infections and neoplastic processes in patients with acquired immune deficiency syndrome (AIDS). However, cardiovascular complications occur in a significant number of such patients and are the immediate cause of death in some. The spectrum of cardiovascular complications of AIDS that may be depicted at imaging includes dilated cardiomyopathy, pericardial effusion, human immunodeficiency virus-associated pulmonary hypertension, endocarditis, thrombosis, embolism, vasculitis, coronary artery disease, aneurysm, and cardiac involvement in AIDS-related tumors. To aid accurate diagnosis and appropriate treatment planning, radiologists should be familiar with the imaging appearance of each of these complications.
Collapse
Affiliation(s)
- Carlos S Restrepo
- Department of Radiology, Louisiana State University Health Sciences Center, 1542 Tulane Ave, Room 212, New Orleans, LA 70112, USA.
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Histopathological Findings in 851 Autopsies of Drug Addicts, With Toxicologic and Virologic Correlations. Am J Forensic Med Pathol 2005. [DOI: 10.1097/01.paf.0000159990.54730.4b] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Bruno R, Sacchi P, Filice G. Overview on the incidence and the characteristics of HIV-related opportunistic infections and neoplasms of the heart: impact of highly active antiretroviral therapy. AIDS 2003; 17 Suppl 1:S83-7. [PMID: 12870535 DOI: 10.1097/00002030-200304001-00012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The manifestation of cardiac involvement in the course of HIV infection has been significantly changed since the introduction of highly active antiretroviral therapy. While in the pre-highly active antiretroviral therapy era the predominant cardiac pathology was represented by localization of opportunistic infection, now new forms of heart involvement are described. Among infectious agents, viruses and bacteria caused the majority of infections. The 'classic' opportunistic agents, such as Toxoplasma, non-tuberculous mycobacteria, cytomegalovirus and Cryptococcus, have virtually disappeared. Endocarditis is still the most frequent infectious disease of the heart in HIV-infected patients, occurring mainly in drug users, and with the improvement in prognosis, the need for cardiac surgery is increasing. Tuberculosis, the incidence of which is still high in poor resources settings where antiretroviral drugs are not available, is a frequent cause of pericarditis, frequently evolving into cardiac tamponade. Recent studies suggest the direct role of HIV as the cause of myocarditis and heart vessel pathology. This finding points out the need of improving our knowledge about the pathogenesis, diagnosis and treatment of this kind of complication.
Collapse
Affiliation(s)
- Raffaele Bruno
- Division of Infectious and Tropical Diseases, IRCCS San Matteo Hospital, Pavia, Italy.
| | | | | |
Collapse
|
21
|
Abstract
As more effective antiretroviral therapies improve survival times, growing numbers of HIV-positive patients are at risk of developing end-organ damage or neoplasia. Heart muscle disease is the most important cardiovascular manifestation of HIV infection and seems set to become increasingly prevalent. This may take the form of either a dilated cardiomyopathy or isolated left or right ventricular dysfunction, is associated with a poor prognosis, and results in symptomatic heart failure in up to 5% of HIV patients. The precise cause of HIV-associated cardiomyopathy remains unclear but is undoubtedly complex, and most probably multifactorial. This report examines our current understanding of the immunopathogenesis of HIV-associated cardiomyopathy.
Collapse
|
22
|
Lewis W. Defective mitochondrial DNA replication and NRTIs: pathophysiological implications in AIDS cardiomyopathy. Am J Physiol Heart Circ Physiol 2003; 284:H1-9. [PMID: 12485813 DOI: 10.1152/ajpheart.00814.2002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
23
|
Affiliation(s)
- Alan S Katz
- Saint Francis Hospital, Research and Education, Roslyn, NY 11576, USA
| | | |
Collapse
|
24
|
Abstract
More effective therapies have improved survival times of HIV+ patients, resulting in a higher prevalence of long-term complications of the disease. This review focuses on HIV-associated cardiovascular pathology, correlating the morphologic findings to clinical syndromes of HIV disease/AIDS.
Collapse
Affiliation(s)
- G d'Amati
- Department of Experimental Medicine and Pathology, La Sapienza University, Rome, Italy.
| | | | | |
Collapse
|
25
|
Dronda F, Moreno S. [Cardiac changes in the chronic HIV-1 infection]. Rev Clin Esp 2001; 201:653-7. [PMID: 11786135 DOI: 10.1016/s0014-2565(01)70940-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- F Dronda
- Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, Spain.
| | | |
Collapse
|
26
|
Hernández Hernández F, Gascueña Rubia R, Escribano Subías P, Velázquez Martín MT, Lombera Romero F, Rubio García R, Pulido Ortega F, Ramón Costa Pérez-Herrero J, Sáenz De La Calzada C. [Diastolic dysfunction in human immunodeficiency virus infection]. Rev Esp Cardiol 2001; 54:1183-9. [PMID: 11591299 DOI: 10.1016/s0300-8932(01)76477-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS We sought to determine the prevalence and characteristics of echocardiographic abnormalities (systolic and/or diastolic dysfunction, pericardial effusion) in patients with human immunodeficiency virus infection (HIV) with no symptoms or previous history of cardiac disease, and compare them with a healthy control group. PATIENTS AND METHOD Transthoracic echocardiography was performed in 125 patients (73% male, mean age 33.2 +/- 6.6 years) with HIV infection without cardiac involvement and 47 age and sex-matched healthy volunteers (78% male, 31.6 +/- 7.3 years). The immunologic situation was determined by CD4 lymphocyte counts. RESULTS Abnormal left ventricular relaxation and filling patterns (E/A relation 1.31 +/- 0.35 in HIV group, 1.66 +/- 0.38 in control group, p < 0.001; pressure half-time 57.5 +/- 13 in HIV group, 50.6 +/- 6.6 in control group, p < 0.001), segmental wall-motion abnormalities (15%) and pericardial effusion (7.2%) were found in patients with HIV infection. Systolic function (EF 64.8 +/- 8.3) and left ventricular dimension (diastolic diameter 4.94 +/- 0.55, systolic diameter 3.17 +/- 0.51) showed normal patterns and did not significantly differ from those of the control group. CONCLUSIONS Silent echocardiographic abnormalities in patients with HIV infection are frequent suggesting a direct myocardial effect of the virus. The development of diastolic dysfunction is directly related to a worse immunologic situation. Prospective studies are needed to clarify the clinical prognosis of these asymptomatic abnormalities.
Collapse
|
27
|
Martínez-García T, Sobrino JM, Pujol E, Galvez J, Benítez E, Girón-González JA. Ventricular mass and diastolic function in patients infected by the human immunodeficiency virus. Heart 2000; 84:620-4. [PMID: 11083740 PMCID: PMC1729508 DOI: 10.1136/heart.84.6.620] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Echocardiographic and Doppler analysis of myocardial mass and diastolic function in patients infected with HIV. DESIGN Case-control study. SETTING Tertiary referral centre, Huelva, Spain. PATIENTS 61 asymptomatic patients with HIV infection and 32 healthy controls. MAIN OUTCOME MEASURES Time motion, cross sectional, and Doppler echocardiographic studies were performed, and left ventricular mass and diastolic function variables determined (peak velocity of early and late mitral outflow and isovolumic relaxation time). RESULTS Left ventricular mass index (LVMI) was decreased in patients compared with healthy controls (mean (SD): 76.7 (23.6) v 118.8 (23.5) g/m(2), p < 0.001). Linear regression analysis showed a correlation between LVMI and brachial fat and muscle areas. The ratio of peak velocities of early and late mitral outflow was decreased in HIV infected patients compared with controls (1.19 (0.44) v 1.58 (0.38), p < 0.001). This ratio was exclusively related to haemodynamic variables (heart rate, systolic and diastolic blood pressures). HIV infected patients had a prolonged isovolumic relaxation time (103.0 (10.5) v 72.9 (12.9) ms, p < 0.001). Isovolumic relaxation time was correlated only with brachial muscle area on multivariate analysis. CONCLUSIONS HIV infected patients had a reduced left ventricular mass index and diastolic functional abnormalities. These cardiac abnormalities are predominantly related to nutritional status.
Collapse
Affiliation(s)
- T Martínez-García
- Department of Internal Medicine, Hospital Juan Ramón Jiménez, Huelva, Spain
| | | | | | | | | | | |
Collapse
|
28
|
Affiliation(s)
- W Lewis
- Department of Pathology, Emory University School of Medicine, 7117 Woodruff Memorial Building, 1639 Pierce Drive, Atlanta, GA 30322, USA.
| |
Collapse
|
29
|
Abstract
This report addresses issues of pathogenesis, pathophysiology, and epidemiology of an increasingly prevalent cardiomyopathy in acquired immunodeficiency syndrome (AIDS). As patient survival increases with more effective antiretroviral therapy, cardiomyopathy in AIDS will become more apparent. The interactions of cellular and organism factors in AIDS and their relationships to the development of cardiomyopathy are reviewed herein. Amongst the factors addressed in this review are: (1) comorbid conditions found with AIDS, (2) the role of inflammatory heart disease and cytokines in the development of AIDS cardiomyopathy, (3) the pathogenetic role of vascular cells and myocardial cells in the development of cardiomyopathy, (4) the role of myocardial retroviral infection in AIDS, and (5) the impact of toxicity from antiretroviral therapy on the development of cardiomyopathy. Because it is possible that more than 1 of these factors is present in a given patient inflicted with AIDS, a multifactorial pathogenesis in AIDS cardiomyopathy must be considered.
Collapse
Affiliation(s)
- W Lewis
- Department of Pathology, Emory University School of Medicine, Atlanta, GA 30322, USA.
| |
Collapse
|
30
|
Hort W, Schwartzkopff B. Anatomie und Pathologie der Koronararterien. PATHOLOGIE DES ENDOKARD, DER KRANZARTERIEN UND DES MYOKARD 2000. [DOI: 10.1007/978-3-642-56944-9_3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
31
|
Chen Y, Brennessel D, Walters J, Johnson M, Rosner F, Raza M. Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature. Am Heart J 1999; 137:516-21. [PMID: 10047635 DOI: 10.1016/s0002-8703(99)70500-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-associated pericardial effusion is common. We present its clinical features, cause, and prognosis on the basis of a review of 40 cases at a single public hospital. METHODS A retrospective study was conducted of 122 patients with pericardial effusion (of which 40 were HIV associated) admitted to Queens Hospital Center from January 1988 to April 1997. A review of the literature is also presented. RESULTS Forty patients with HIV-associated pericardial effusion represent 33% of the 122 patients with pericardial effusion admitted during that period. The most common symptom of the 40 patients was dyspnea (75%). Echocardiogram detected small effusions in 18 (45%), moderate effusions in 10 (25%), and large effusions in 12 (30%). Sixteen (40%) patients had cardiac tamponade, in 15 of whom pericardiocentesis or pericardiostomy was performed. Causes of cardiac tamponade were Mycobacterium species in 3 (19%), Streptococcus pneumoniae in 1 (6%), Staphylococcus aureus in 1 (6%), Kaposi's sarcoma in 1 (6%), and unknown in 10 (63%). In comparison, causes of cardiac tamponade in 74 cases of acquired immunodeficiency syndrome in the literature were 45% idiopathic, 20% mycobacteria, 19% bacteria, 7% lymphoma, 5% Kaposi's sarcoma, 3% viruses, and 1% fungus. Thirteen of the 40 patients were lost to follow-up. Among the other 27, 11 (41%) were alive at 3 months and 5 (19%) at 1 year. Ten of the 27 patients had cardiac tamponade, of whom 5 (50%) were alive at 3 months and 3 (30%) at 1 year. CONCLUSIONS HIV-associated pericardial effusion is the most common type of pericardial effusion in our inner city hospital. Causes are diverse. The development of pericardial effusion predicts a poor prognosis in HIV infection.
Collapse
Affiliation(s)
- Y Chen
- Department of Medicine, Mount Sinai Services at Queens Hospital Center,Jamaica, NY, USA
| | | | | | | | | | | |
Collapse
|
32
|
Milei J, Grana D, Fernández Alonso G, Matturri L. Cardiac involvement in acquired immunodeficiency syndrome--a review to push action. The Committee for the Study of Cardiac Involvement in AIDS. Clin Cardiol 1998; 21:465-72. [PMID: 9669054 PMCID: PMC6656289 DOI: 10.1002/clc.4960210704] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/1998] [Accepted: 04/06/1998] [Indexed: 11/06/2022] Open
Abstract
As more effective therapies have produced longer survival times for human immunodeficiency virus (HIV)-infected patients, new complications of late-stage HIV infection including HIV-related heart disease have emerged. Almost any agent that can cause disseminated infection in patients with acquired immunodeficiency syndrome (AIDS) may involve myocardium, but clinical evidence of cardiac disease is usually overshadowed by manifestations in other organs, primarily the brain and lungs. Cardiac abnormalities are found at autopsy in two-thirds of patients with AIDS, and more than 150 reports of cardiac complications have been published. Cardiac involvement in HIV disease includes pericardial effusion, myocarditis, dilated cardiomyopathy, and/or endocardial involvement at any stage of the disease. This review deals with all the cardiac manifestations of AIDS and serves to highlight two problems and one indication. First of all, there are very few clinical studies. Current knowledge is based almost exclusively on echocardiography and autopsy studies. Observational or clinical trials would be useful. Second, there exists very poor information on the impact of treatment; and epidemiologic and clinicopathologic studies are mandatory for obtaining detailed data concerning the mechanisms of myocardial damage in AIDS. Finally, because cardiac complications are often clinically inapparent or subtle in the initial stages, periodic screening of HIV-positive patients by electrocardiogram and echocardiogram is probably indicated. In addition, AIDS may also provide the opportunity to gain insights into the pathogenesis of little understood cardiac diseases such as lymphocytic myocarditis and dilated cardiomyopathy.
Collapse
Affiliation(s)
- J Milei
- Hospital Fernández, Universidad de Buenos Aires, Argentina
| | | | | | | |
Collapse
|
33
|
Currie PF, Goldman JH, Caforio AL, Jacob AJ, Baig MK, Brettle RP, Haven AJ, Boon NA, McKenna WJ. Cardiac autoimmunity in HIV related heart muscle disease. Heart 1998; 79:599-604. [PMID: 10078089 PMCID: PMC1728716 DOI: 10.1136/hrt.79.6.599] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the frequency of circulating cardiac specific autoantibodies in HIV positive patients with and without echocardiographic evidence of left ventricular dysfunction. SUBJECTS 74 HIV positive patients including 28 with echocardiographic evidence of heart muscle disease, 52 HIV negative people at low risk of HIV infection, and 14 HIV negative drug users who had all undergone non-invasive cardiac assessment were studied along with a group of 200 healthy blood donors. RESULTS Cardiac autoantibodies detected by indirect immunofluorescence (serum dilution 1/10) were more common in the HIV positive patients (15%), particularly the HIV heart muscle disease group (21%), than in HIV negative controls (3.5%) (both p < 0.001). By ELISA (dilution 1/320), abnormal anti-alpha myosin autoantibody concentrations were found more often in HIV patients with heart muscle disease (43%) than in HIV positive patients with normal hearts (19%) or in HIV negative controls (3%) (p < 0.05 and p < 0.001, respectively). Anti-alpha myosin autoantibody concentrations were greater in HIV positive patients than in HIV negative controls, regardless of cardiac status ((mean SD) 0.253 (0.155) v 0.170 (0.076); p = 0.003). In particular the mean antibody concentration was higher in the HIV heart muscle disease patients (0.291 (0.160) v 0.170 (0.076); p = 0.001) than in HIV negative controls. On follow up, six subjects with normal echocardiograms but raised autoantibody concentrations had died after a median of 298 days, three with left ventricular abnormalities at necropsy. This compared with a median survival of 536 days for 21 HIV positive patients with normal cardiological and immunological results. CONCLUSIONS There is an increased frequency of circulating cardiac specific autoantibodies in HIV positive individuals, particularly those with heart muscle disease. The data support a role for cardiac autoimmunity in the pathogenesis of HIV related heart muscle disease, and suggest that cardiac autoantibodies may be markers of the development of left ventricular dysfunction in HIV positive patients with normal hearts.
Collapse
Affiliation(s)
- P F Currie
- Department of Cardiology, Royal Infirmary of Edinburgh, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Guillamón Torán L, Romeu Fontanillas J, Forcada Sáinz JM, Curós Abadal A, Larrousse Pérez E, Valle Tudela V. [Heart pathology of extracardiac origin (I). Cardiac involvement in AIDS]. Rev Esp Cardiol 1997; 50:721-8. [PMID: 9417563 DOI: 10.1016/s0300-8932(97)73289-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A great variety of cardiac disorders have been reported in HIV-infected patients: pericarditis, myocarditis, cardiomyopathies, endocarditis, cardiac involvement through malignancies, pulmonary hypertension, arrhythmias and thromboembolic disease. In general, these disorders are asymptomatic and often diagnosed in echocardiographic studies or autopsies. Pericardial involvement is the most common disorder. Pericardial effusions are asymptomatic and non-specific in a great proportion, but in some instances opportunistic infections or malignancies may lead to cardiac tamponade and are associated with an increased risk of mortality. The etiopathogenesis of myocarditis and cardiomyopathies is uncertain. There is controversy about the role of HIV as the primary etiologic agent. Opportunistic infections, cardiotoxic substances, nutritional deficiencies and autoimmune reactions have also been implicated as etiologic agents of myocardial damage. Short-term prognosis worsens as clinical manifestations of heart failure appear. Valvular involvement usually presents as marantic or infectious endocarditis, the latter most frequently in IVDU. This article reviews the main cardiovascular manifestations in AIDS.
Collapse
Affiliation(s)
- L Guillamón Torán
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona
| | | | | | | | | | | |
Collapse
|
35
|
Minamoto GY, Rosenberg AS. Fungal infections in patients with acquired immunodeficiency syndrome. Med Clin North Am 1997; 81:381-409. [PMID: 9093234 DOI: 10.1016/s0025-7125(05)70523-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The incidence and severity of fungal infections appear to increase with progression of HIV disease. Because of the significant morbidity and mortality associated with the mycoses discussed, knowledge of the clinical syndromes, early diagnosis, and prompt institution of therapy are crucial for a favorable outcome. For disseminated or invasive fungal infections, suppressive therapy must be continued to prevent relapse.
Collapse
Affiliation(s)
- G Y Minamoto
- Department of Clinical Medicine, Columbia University, New York, New York, USA
| | | |
Collapse
|
36
|
|
37
|
Casalino E, Laissy JP, Soyer P, Bouvet E, Vachon F. Assessment of right ventricle function and pulmonary artery circulation by cine-MRI in patients with AIDS. Chest 1996; 110:1243-7. [PMID: 8915228 DOI: 10.1378/chest.110.5.1243] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To evaluate right ventricle (RV) anatomy and performance and its relationships with pulmonary circulation in AIDS patients. DESIGN We conducted a prospective blinded study by using cine-MRI, a well-accepted method to assess RV and pulmonary circulation. SETTING A university hospital. PARTICIPANTS Ten healthy volunteers and 13 asymptomatic AIDS patients. MEASUREMENTS RV end-diastolic and end-systolic volumes, RV ejection fraction (RVEF), pulmonary artery (PA) diameter, main pulmonary artery distensibility (MPAD), RV free wall diastolic thickness (RVWT), and RV mass were measured. The RVWT/left ventricular wall thickness index was calculated. RESULTS AIDS patients had significantly increased RV end-diastolic and end-systolic volumes and decreased RVEF (50 +/- 10 vs 59 +/- 6; p < 0.03). Four AIDS patients had RV wall motion abnormalities; 5 (38%) had an RVEF under 45%. RVWT, the RVWT/left ventricular wall thickness index, and PA diameter were significantly increased in AIDS patients. RV mass was increased in 54% of AIDS patients. MPAD was significantly lower in AIDS patients (18.8 +/- 15 vs 26 +/- 4; p < 0.01). A significant relationship was found between RV mass and MPAD (r = 0.76; p = 0.02). CONCLUSIONS RV function is frequently impaired in AIDS patients. Anatomic and functional abnormalities found in RV and PA parameters suggest a systolic overload on RV. Pulmonary circulation abnormalities may influence RV structure and function in AIDS patients.
Collapse
Affiliation(s)
- E Casalino
- Infectious Disease Intensive Care Unit, Bichat-Claude Bernard University Hospital, Paris, France
| | | | | | | | | |
Collapse
|
38
|
Abstract
Cardiac involvement in HIV infection was previously believed to be an unusual manifestation of the disease, but is now being described with increasing frequency. It may be a well-characterized cardiac disease occurring coincidentally in an AIDS patient, a complication of AIDS or its treatment, or possibly a direct result of HIV infection of the heart. In this article, the authors describe the emerging patterns of heart and vascular diseases in HIV-infected patients, pathogenic mechanisms, and implications for treatment.
Collapse
Affiliation(s)
- R C Patel
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | | |
Collapse
|
39
|
Heidenreich PA, Eisenberg MJ, Kee LL, Somelofski CA, Hollander H, Schiller NB, Cheitlin MD. Pericardial effusion in AIDS. Incidence and survival. Circulation 1995; 92:3229-34. [PMID: 7586308 DOI: 10.1161/01.cir.92.11.3229] [Citation(s) in RCA: 149] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Although pericardial effusion is known to be common among patients infected with HIV, the incidence of pericardial effusion and its relation to survival have never been described. METHODS AND RESULTS To evaluate the incidence of pericardial effusion and its relation to mortality in HIV-positive subjects, 601 echocardiograms were performed on 231 subjects recruited over a 5-year period (inception cohort: 59 subjects with asymptomatic HIV, 62 subjects with AIDS-related complex, and 74 subjects with AIDS; 21 HIV-negative healthy gay men; and 15 subjects with non-HIV end-stage medical illness). Echocardiograms were performed every 3 to 6 months (82% had follow-up studies). Sixteen subjects were diagnosed with effusions (prevalence of effusion for AIDS subjects entering the study was 5%). Thirteen subjects developed effusions during follow-up; 12 of these were subjects with AIDS (incidence, 11%/y). The majority of effusions (80%) were small and asymptomatic. The survival of AIDS subjects with effusions was significantly shorter (36% at 6 months) than survival for AIDS subjects without effusions (93% at 6 months). This shortened survival remained significant (relative risk, 2.2, P = .01) after adjustment for lead time bias and was independent of CD4 count and albumin level. CONCLUSIONS There is a high incidence of pericardial effusion in patients with AIDS, and the presence of an effusion is associated with shortened survival. The development of an effusion in the setting of HIV infection suggests end-stage HIV disease (AIDS).
Collapse
Affiliation(s)
- P A Heidenreich
- Division of Cardiology, University of California, San Francisco, USA
| | | | | | | | | | | | | |
Collapse
|
40
|
Patel RC, Frishman WH. AIDS and the heart: Clinicopathologic assessment. Cardiovasc Pathol 1995; 4:173-83. [DOI: 10.1016/1054-8807(95)00022-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/1994] [Accepted: 02/27/1995] [Indexed: 12/17/2022] Open
|
41
|
Abstract
BACKGROUND The leading cause of pericardial effusion in urban hospitals is now AIDS-related pathologies. Clinically, these effusions are a diagnostic and management dilemma. In our institution, pericardial biopsy and operative drainage have become part of the diagnostic and management plan. Surgical intervention, however, has appeared to have little clinical impact. METHODS A retrospective review was conducted of all patients (n = 29) diagnosed as having AIDS who underwent "pericardial window" for pericardial effusions from 1986 to 1994. RESULTS Fluid cultures and pericardial biopsy were performed in all cases. Twenty-four percent of culture or biopsy specimens were diagnostic (7 of 29 = 2 adenocarcinoma, 3 lymphoma, 1 Staphylococcus aureus, 1 Mycobacterium tuberculosis). In 94% of cases, there was no change in clinical management based on operative results. In 4 of 7 cases, the patients were ineligible for the indicated therapy based on underlying illness and in 1 of 7, the patient was receiving appropriate therapy for previously diagnosed disease. Ventilatory complications were noted in 17%. Three patients did not wean from the ventilator and died shortly after the operation. Sixty-nine percent mortality was noted at 8 weeks post-operatively. One hundred percent mortality was noted at 22 weeks with 86% follow-up. CONCLUSION AIDS-related pericardial effusion is associated with a grave prognosis. Operations for diagnostic benefit provide little practical information and are not justified.
Collapse
Affiliation(s)
- D R Flum
- Department of Surgery, St. Vincent's Hospital and Medical Center, New York, NY 10011, USA
| | | | | |
Collapse
|
42
|
Abstract
The ever-spreading incidence of infection with the human immunodeficiency virus (HIV) has introduced a spectrum of unusual, subtle, and often life-threatening lesions that can affect almost every organ and tissue in the body. With the introduction of laboratory serologic evidence of HIV infection, the spectrum of indicator diseases has extended beyond the classic opportunistic infections and Kaposi sarcoma. An analysis of 28 patients in Zimbabwe with focal areas of vascular disease treated during a 4-year period (1989-1993) defined 16 patients ranging in age from 12 to 46 years appropriate for special scrutiny as they evinced none of the usual causes of vascular disease. Twelve of the patients were HIV-positive; in two patients the serologic status was unknown; and two patients were HIV-negative at the time of their presentation. There were special clinical features in this group of patients selected for study: (1) They were young with a mean age of 31 years; (2) they were all indigenous Africans with no evidence of atherosclerosis; and there was (3) rapid development of focal necrotizing vasculitis with aneurysm formation and rupture or (4) slow, progressive development of granulomatous vasculitis. The sites of cardiovascular involvement included the left ventricle; aortic arch; thoracic, thoracoabdominal, and abdominal aorta; and iliac, femoral, gluteal, popliteal, and subclavian arteries. It is inferred that the association between HIV-positive status and arterial aneurysms or fibroproliferative aortic occlusion are causally related and that the principles of vascular surgery can be successfully applied to their treatment.
Collapse
Affiliation(s)
- C Marks
- Department of Cardiothoracic Surgery, Parirenyatwa Hospital, Borrowdale, Harare, Zimbabwe
| | | |
Collapse
|
43
|
Cegielski JP, Lwakatare J, Dukes CS, Lema LE, Lallinger GJ, Kitinya J, Reller LB, Sheriff F. Tuberculous pericarditis in Tanzanian patients with and without HIV infection. TUBERCLE AND LUNG DISEASE : THE OFFICIAL JOURNAL OF THE INTERNATIONAL UNION AGAINST TUBERCULOSIS AND LUNG DISEASE 1994; 75:429-34. [PMID: 7718831 DOI: 10.1016/0962-8479(94)90116-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
SETTING Large academic medical center in Tanzania. OBJECTIVES To determine the etiologies and outcomes of large pericardial effusions in HIV-infected and uninfected patients. DESIGN Prospective cohort study of patients admitted with new large pericardial effusions, confirmed echocardiographically. Patients had pericardial biopsies and drainage with extensive analysis of tissue and fluid specimens, and were followed with clinical and echocardiographic examinations. RESULTS Of 28 patients with large pericardial effusions, 19 were infected with HIV-1. 22 had invasive diagnostic procedures: 14 of 14 HIV-infected patients, but only 4 of 8 non-HIV-infected patients, had tuberculous pericarditis (P = 0.01). All but 1 of the HIV-infected patients had strongly positive tuberculin skin tests, and short-term outcomes were similar in the 2 groups. CONCLUSION TB is the predominant cause of large pericardial effusion in HIV-infected patients in this setting; non-HIV-infected patients are more likely to have other etiologies. These patients were at an early stage of HIV infection and responded well to treatment. In settings where microbiological studies are not routinely available, HIV-infected patients with large pericardial effusions may be treated empirically for tuberculosis and monitored for improvement. If improvement does not follow within 2-4 weeks further studies are indicated. HIV-negative patients should undergo diagnostic evaluation initially.
Collapse
Affiliation(s)
- J P Cegielski
- Duke University Medical Center, Durham, NC 27710, USA
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Aboulafia DM, Bush R, Picozzi VJ. Cardiac tamponade due to primary pericardial lymphoma in a patient with AIDS. Chest 1994; 106:1295-9. [PMID: 7924524 DOI: 10.1378/chest.106.4.1295] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Cardiac tamponade due to lymphomatous involvement of the heart is a dramatic and unusual complication. Because of their nonspecific clinical presentation, these tumors are seldom diagnosed antemortem. We report the case of a patient with AIDS who presented with signs and symptoms of cardiac tamponade. Emergency pericardiocentesis followed by staging studies revealed large cell B-lymphocyte lymphoma confined to the pericardial space. With combination chemotherapy, a durable complete response was obtained. This case illustrates the potential benefit of aggressive treatment of extranodal non-Hodgkin's lymphoma in a patient with AIDS. The case is of particular interest because of the unusual development of isolated pericardial involvement as the sentinel sign of lymphoma.
Collapse
Affiliation(s)
- D M Aboulafia
- Section of Hematology and Oncology, University of Washington, Seattle
| | | | | |
Collapse
|
45
|
De Castro S, d'Amati G, Gallo P, Cartoni D, Santopadre P, Vullo V, Cirelli A, Migliau G. Frequency of development of acute global left ventricular dysfunction in human immunodeficiency virus infection. J Am Coll Cardiol 1994; 24:1018-24. [PMID: 7930192 DOI: 10.1016/0735-1097(94)90864-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES This study evaluated prospectively the frequency, clinical outcome and pathologic findings of acute global left ventricular dysfunction in human immunodeficiency virus (HIV) infection during the various stages of the disease. BACKGROUND Acute global left ventricular dysfunction in the course of HIV infection is still a poorly defined clinical entity, and little is known about the outcome after the acute onset. METHODS Between January 1988 and June 1992, 136 HIV-positive (HIV+) patients without clinical, electrocardiographic or echocardiographic evidence of cardiovascular dysfunction on admission were prospectively studied with serial echocardiograms. Patients were assigned to three groups: 1) anti-HIV+ asymptomatic (17 patients, 12.5%); 2) acquired immunodeficiency syndrome (AIDS)-related complex (26 patients, 19.1%); 3) AIDS (93 patients, 68.4%). RESULTS During a mean follow-up period of 415 +/- 220 days, seven patients, all in the AIDS subgroup, developed clinical and echocardiographic findings of acute global left ventricular dysfunction; of these, six (85%) died of congestive heart failure. Mean survival time from symptom onset was 41 +/- 13 days. Necropsy findings in five patients revealed acute lymphocytic myocarditis in three, cryptococcal myocarditis in one and interstitial edema and fibrosis in one. In only one patient was left ventricular dysfunction reversible with treatment. CONCLUSIONS Although infrequent, acute global left ventricular dysfunction is not rare in the course of HIV infection. It seems to occur exclusively during the AIDS stage. Acute global left ventricular dysfunction is often fatal but may be reversible and is mainly associated with the pathologic findings of acute myocarditis.
Collapse
Affiliation(s)
- S De Castro
- Institute of the Sixth Medical Clinic, La Sapienza University, Rome, Italy
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Kwan T, Karve MM, Emerole O. Cardiac tamponade in patients infected with HIV. A report from an inner-city hospital. Chest 1993; 104:1059-62. [PMID: 8404166 DOI: 10.1378/chest.104.4.1059] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Thirty-seven consecutive cases of cardiac tamponade occurring over a 6-year period were retrospectively studied from January 1986 to December 1991 in an inner-city public teaching hospital. All episodes were secondary to medical illnesses. Thirteen (35 percent) of 37 patients had HIV infection. Significant differences (HIV vs non-HIV) in clinical presentation were noted in the following parameters: (1) age (34 +/- 7 years vs 56 +/- 14 years, p < 0.001); (2) febrile presentation (62 percent vs 17 percent, p < 0.02); and (3) presence of pulmonary infiltrates (54 percent vs 17 percent, p < 0.03). All but two patients underwent pericardiocentesis or had operative creation of a pericardial window. Two patients had purulent pericarditis; two patients had tuberculous pericarditis. In the remaining patients, there was no evidence of opportunistic infection or malignancy based on cultures of pericardial fluid and histopathologic analysis of tissue. Six of 13 patients with HIV infection survived to be discharged from the hospital following hospitalization for the illness. We conclude the following: (1) HIV infection is frequently found in patients with cardiac tamponade at inner city hospitals; (2) when young patients present with cardiac tamponade, the coexistence of fever and pulmonary infiltrates is suggestive of underlying HIV infection; and (3) the etiology of the pericardial effusion is not confirmed in the majority of patients with HIV infection.
Collapse
Affiliation(s)
- T Kwan
- Department of Medicine, State University of New York, Health Science Center, Brooklyn
| | | | | |
Collapse
|
47
|
Abstract
Pericardial effusions in patients with the acquired immunodeficiency syndrome (AIDS) can be due to a variety of causes and are often large enough to be sampled for cytologic examination. Over a period of 46 months, 15 cytologic specimens from 14 patients with AIDS were examined. Thirteen patients were male, one was female; the age range was 26 to 43 years. All male patients were homosexual or intravenous drug abusers, and the female patient was the spouse of an intravenous drug abuser. In general, the cytology specimens were moderately cellular with inflammatory cells seen in all cases. Atypical or reactive mesothelial cells were found in 12 cases (80%), and the atypia in one of these 12 was so marked that carcinoma was suspected; cells suspicious for malignant lymphoma were found in 2 cases (13%); degenerated mesothelial cells were present in one case. No infections were identified in this series. Ten patients (66%) had subsequent pericardial biopsies. Marked cellularity and nuclear pleomorphism in lymphoid cells with an altered nuclear cytoplasmic ratio were the dominant findings in the two suspected lymphoma cases. Both patients had known lymphoma elsewhere; in one, involvement by lymphoma was also found on pericardial biopsy. Mesothelial proliferations showing papillary formations with psammoma bodies were seen in three cases; in one of these, histoplasmosis was later diagnosed by pericardial biopsy. To our knowledge this is the first series to describe cytologically the marked mesothelial atypia seen in pericardial fluid in AIDS patients. We contrast this atypia with that seen in malignant effusions and caution against overinterpretation of pericardial fluids from AIDS patients.
Collapse
Affiliation(s)
- M F Zakowski
- Department of Pathology, Bellevue Hospital, New York University Medical Center, NY
| | | |
Collapse
|
48
|
Reynolds MM, Hecht SR, Berger M, Kolokathis A, Horowitz SF. Large pericardial effusions in the acquired immunodeficiency syndrome. Chest 1992; 102:1746-7. [PMID: 1446483 DOI: 10.1378/chest.102.6.1746] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The increasing importance of the acquired immunodeficiency syndrome (AIDS) as a cause of large, clinically significant pericardial effusions has not been well documented. To determine the frequency and characteristics of large AIDS-associated pericardial effusions, we reviewed the records of 50 consecutive patients undergoing pericardiocentesis between 1985 and 1990; AIDS was the most common underlying illness and was present in 14 patients (28 percent). The pericardial fluid was diagnostic in three (21 percent) of the 14 cases (one bacterial, one positive for acid-fast bacilli, and one lymphoma). Of the 11 patients with nondiagnostic fluid, one underwent a pericardial biopsy which revealed granuloma consistent with mycobacterial disease, four had active pulmonary tuberculosis (TB), and two responded clinically to anti-TB therapy. Thus, in 8 (57 percent) of the 14 patients with AIDS, there was either definitive or suggestive evidence of mycobacterial disease. We conclude that AIDS is now a common underlying illness associated with large pericardial effusions and that mycobacterial disease may frequently be the etiology.
Collapse
Affiliation(s)
- M M Reynolds
- Division of Cardiology, Beth Israel Medical Center, New York, New York 10003
| | | | | | | | | |
Collapse
|
49
|
d'Amati G, Kwan W, Lewis W. Dilated cardiomyopathy in a zidovudine-treated AIDS patient. Cardiovasc Pathol 1992; 1:317-20. [DOI: 10.1016/1054-8807(92)90042-m] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/1992] [Accepted: 07/14/1992] [Indexed: 10/26/2022] Open
|
50
|
Abstract
Following a case of cardiac tamponade in a patient with the acquired immunodeficiency syndrome (AIDS), we examined the frequency and clinical spectrum of pericardial effusions associated with human immunodeficiency virus infection (HIV) at our institution. Of 187 hospitalized patients documented to have pericardial effusions over a one-year period, 14 (7 percent) were known to be HIV-positive at the time of their echocardiograms. One patient presented with a large effusion and cardiac tamponade, three had moderate effusions, and ten had small effusions. The probable effusion etiology was established in four cases and included endocarditis (2), lymphoma (1), and myocardial infarction (1). In hospital mortality was 29 percent (4 of 14). From our study, as well as a growing number of reports in the literature, we conclude that HIV-associated pericardial effusions are frequently seen and that their clinical spectrum is broad.
Collapse
Affiliation(s)
- M J Eisenberg
- Department of Medicine, University of California, San Francisco
| | | | | |
Collapse
|