Cardiac Mechanics in Patients With Human Immunodeficiency Virus: A Study of Systolic Myocardial Deformation in Children and Young Adults

Abstract

Human immunodeficiency virus (HIV) infection causes dysfunction of different organ systems. Myocardial diastolic dysfunction has been reported previously in an adult HIV population. Our aim was to study myocardial strain in children and young adults infected by HIV who have apparently normal ejection fraction. Forty HIV-infected patients (mean age 20.6 ± 1.5 years) with normal ejection fraction and 55 matched normal controls (mean age 17 ± 1.5 years) were studied by two-dimensional echocardiogram. The images were stored then exported to velocity vector imaging software for analysis. Measures considered were left-ventricular peak global systolic strain (LV S) and strain rate (LV SR) as well as right-ventricular peak global systolic strain (RV S) and strain rate (RV SR). Circumferential measures of the left ventricle included the following: LV circumferential peak global systolic strain (LV circ S), strain rate (LV circ SR), radial velocity (LV rad vel), and rotational velocity (LV rot vel) at the level of the mitral valve. Statistical significance was set at p < 0.05. The means of all longitudinal deformation parameters were significantly lower in HIV patients compared with normal controls: LV S (-14.15 vs. -19.31), LV SR (-0.88 vs. -1.30), RV S (-19.58 vs. -25.09), and RV SR (-1.34 vs. -2.13), respectively (p < 0.05). LV rot vel was lower in patients compared with controls (43.23 vs. 51.71, p = 0.025). LV circ S, LV circ SR, and LV rad vel showed no significant difference between the two groups (p ≥ 0.05). HIV infection affects longitudinal systolic cardiac strain and strain rate in children and young adults. Normal ejection fraction might be attributed to preserved circumferential myocardial deformation. Strain and strain rate may help identify HIV patients at high risk for cardiac dysfunction and allow early detection of silent myocardial depression.

Assessment of Biventricular Function by Three-Dimensional Speckle Tracking Echocardiography in Adolescents and Young Adults with Human Immunodeficiency Virus Infection: A Pilot Study

“…In HIV-infected patients LV twist and torsion changes are less well defined. In patients who acquired HIV disease from their mothers antenatally it has been reported significant decrease of LV rotational velocity compared to normal controls (13).…”

“…Two-dimensional speckle tracking echocardiography (2D-STE) has emerged as a new means of assessment of myocardial wall movements and deformation (10,11) and more sensitive compared to ejection fraction in detecting early changes in ventricular performance (12)(13)(14)(15). 2D-STE capability is limited by the changes in heart morphology during the cardiac cycle and the difficulty in tracking speckles in different frames because of out of plane motion.…”

Human Immunodeficiency Virus and Heart Failure in Low- and Middle-Income Countries

“…Asymptomatic, otherwise healthy PLHIV have lower strain and strain rates than HIV-uninfected people (86). HIV infection appears to affect mainly longitudinal systolic cardiac strain with preserved circumferential myocardial deformation (Figure 3) (87). Magnetic resonance imaging shows that these subclinical changes may relate to myocardial fibrosis and steatosis (84).…”

Applications of the Myocardial Strain Study using Two-Dimensional Speckle Tracking in Pediatrics

“…29 Trabalhos mais recentes realizados em crianças e adultos jovens comprovaram comprometimento do strain longitudinal de ventrículo direito (VD) e VE, ainda em pacientes assintomáticos e com fração de ejeção do VE normal. Diante destes resultados, Naami et al 30 sugeriram a incorporação do estudo da deformação miocárdica aos ecocardiogramas dos pacientes pediátricos com HIV, com o objetivo de identificar pacientes com disfunção subclínica e com maior risco cardiovascular.…”