Impact of HIV infection on cardiac deformation

Abstract

Aim: The aim of this study was to detect abnormalities in left ventricular myocardial function due to HIV (human immunodeficiency virus) infection without established cardiovascular disease. Methods: An echocardiogram was performed in 50 asymptomatic HIV-infected patients (age 41±6 years, 64% male) and in 20 healthy individuals. Conventional echocardiography and pulsed tissue Doppler imaging (TDI) were performed according to the guidelines. The strain rate of the basal segments was obtained with color tissue Doppler and used to evaluate systolic strain rate (SRS), early diastolic strain rate (SRE) and late diastolic strain rate (SRA). Longitudinal, radial and circumferential strain were assessed by 2D speckle tracking. Results: The mean duration of HIV infection was 10±5 years, CD4 count was 579±286 cells/mm3, 32% had detectable viral load, and 86% were under treatment. Of the HIV-infected patients, one had grade 1 diastolic dysfunction. The groups were not different except for E wave (HIV 0.72±0.17 m/s vs. control 0.84±0.16 m/s, p=0.01), longitudinal strain (−19.5±1.9% vs. −21±2%, p=0.005), SRS (−1.1±0.28 s−1 vs. −1.3±0.28 s−1, p=0.02) and SRE (1.8±0.4 s−1 vs. 2.2±0.4 s−1, p<0.001), but only SRS (p=0.03, 95% CI 0.036; 0.67) and SRE (p=0.001, 95% CI −0.599; −0.168) had independent value. Conclusion: In an HIV-infected population without established cardiovascular disease, myocardial deformation abnormalities can be detected with strain and strain rate, revealing markers of myocardial injury. Resumo: Objetivo: Determinar alterações na função miocárdica secundárias à infeção do vírus da imunodeficiência humana (VIH) em doentes sem doença cardiovascular estabelecida. Métodos: Foram realizados ecocardiogramas em 50 doentes com infeção VIH, assintomáticos (41±6 anos, 64% homens) e em 20 indivíduos saudáveis. O ecocardiograma convencional e o Doppler tecidular pulsado foram realizados e determinados segundo as últimas recomendações. O strain rate dos segmentos basais foram determinados com o Doppler tecidular cor e avaliados o strain rate sistólico (SRS), o strain rate diastólico precoce (SRE) e o strain rate diastólico tardio (SRA). O strain longitudinal, radial e circunferencial foi obtido a partir do 2D speckle tracking. Resultados: Na amostra a duração da infeção era de 10±5 anos, com contagem de CD4 de 579±286 células/mm3, 32% tinham carga viral detetável e 86% estavam em terapêutica ativa. No grupo infetado, um doente tinha disfunção diastólica de grau 1. Os grupos eram semelhantes, exceto para a onda E (VIH 0,72±0,17 m/s versus control 0,84±0,16 m/s, p=0,01), strain longitudinal (–19,5±1,9% versus –21±2%, p=0,005), SRS (–1,1±0,28 s-1 versus –1,3±0,28 s-1, p=0,02) e SRE (1,8±0,4 s-1 versus 2,2±0,4 s-1, p<0,001), mas só o SRS (p=0,03, 95% CI 0,036; 0,67) e o SRE (p=0,001, 95%CI –0,599; –0,168) foram diferentes na análise multivariada. Conclusão: Numa população infetada com o VIH, mas sem doença cardiovascular estabelecida, as alterações na deformação miocárdica podem ser apercebidas através do strain e do strain rate, revelando possíveis marcadores de lesão miocárdica. Keywords: HIV infection, Myocardial mechanics, Myocardium deformation, Speckle tracking, Color tissue Doppler, Palavras-chave: Infeção VIH, Mecanismos miocárdicos, Deformação miocárdica, Speckel tracking, Doppler tecidular