Cardiovascular magnetic resonance characterisation of pericardial and myocardial involvement in patients with tuberculous pericardial constriction with and without HIV co-infection

Ntusi, Ntobeko; Palkowski, Gregori H; Samuels, Petronella; Moosa, Sulaiman; Ntsekhe, Mpiko; Mayosi, Bongani M.

doi:10.1186/1532-429x-18-s1-q29

Cited by 3 publications

(4 citation statements)

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“…Mortality of pericardial effusions in HIV-infected patients is based on the severity and aetiology of the disease, especially if associated with tuberculosis [69]. We have demonstrated more frequent myocardial fibrosis in HIV-associated pericardial constriction when compared to those without HIV infection [35]. Prednisone does not reduce mortality in tuberculous pericarditis, but has been shown to be associated with reduced hospitalisation and constriction, but with increased risk of malignancies in those with HIV infection [70].…”

Section: Pericardial Disease In Hivmentioning

confidence: 81%

“…Direct invasion of cardiomyocytes by HIV has been described, however, the virus affects the myocardial cells in a haphazard fashion with no clear association between viral load and extent of myocardial involvement [30]. The invasion of cardiomyocytes in HIV infection can be through other microorganisms, including fungi (Candida, Histoplasma capsulatum [31], Cryptococcus neoformans [32], Aspergillus [32]); viruses (Herpes simplex [33], cytomegalovirus [30], Coxsackievirus B3 [34], Parvovirus [33]); bacteria (Mycobacterium tuberculosis [35], Mycobacterium avium [36]) and parasites (Toxoplasma gondii [37]).…”

Section: Myocarditis In Hivmentioning

confidence: 99%

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HIV-Associated Cardiovascular Disease

Saad¹,

Ntusi²

2018

Advances in HIV and AIDS Control

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Currently, 17 million people worldwide are receiving antiretroviral therapy (ART) for human immunodeficiency viral (HIV) infection. There has been a dramatic decline in mortality from HIV infection in the last decade due to increased availability of ART. HIVassociated cardiac failure is on the increase, with more cases of diastolic dysfunction reported in the ART era. HIV increases the risk of CVD, because of longer survival on ART, ongoing subclinical inflammation, traditional cardiovascular risk factors and the complications of chronic ART use. HIV-associated CVD encompasses a wide spectrum of heterogeneous clinical entities, which include diastolic dysfunction, asymptomatic left ventricular dysfunction, cardiomyopathy, myocarditis, heart failure, myocardial fibrosis, myocardial steatosis, pulmonary hypertension, peripheral arterial disease, cerebrovascular disease, infective endocarditis, coronary artery disease and cardiac neoplasms (e.g. Kaposi sarcoma and B-cell immunoblastic lymphoma). In this chapter, we review the complex association of HIV infection and CVD. We describe important recent developments and perspectives based on a systematic analysis of the important advances in this field published in the last decade.

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Section: Pericardial Disease In Hivmentioning

confidence: 81%

Section: Myocarditis In Hivmentioning

confidence: 99%

HIV-Associated Cardiovascular Disease

Saad¹,

Ntusi²

2018

Advances in HIV and AIDS Control

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“…a T2-weighted STIR imaging with thickened visceral and parietal pericardium. b Fibrotic pericardial layers after administration of gadolinium (reproduced with permission from Ntusi et al [56]) biopsy samples, with an additional 13.3% being diagnosed by identification of granulomatous inflammation on histology [30].…”

Section: Diagnosing Tuberculous Pericarditismentioning

confidence: 99%

Diagnosis and Management of Tuberculous Pericarditis: What Is New?

et al. 2020

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Purpose of Review This review provides an update on the immunopathogenesis of tuberculous pericarditis (TBP), investigations to confirm tuberculous etiology, the limitations of anti-tuberculous therapy (ATT), and recent efficacy trials. Recent Findings A profibrotic immune response characterizes TBP, with low levels of AcSDKP, high levels of γ-interferon and IL-10 in the pericardium, and high levels of TGF-β and IL-10 in the blood. These findings may have implications for future therapeutic targets. Despite advances in nucleic acid amplification approaches, these tests remain disappointing for TBP. Trials of corticosteroids and colchicine have had mixed results, with no impact on mortality, evidence of a reduction in rates of constrictive pericarditis and potential harm in those with advanced HIV. Small studies suggest that ATT penetrates the pericardium poorly. Given that there is a close association between high bacillary burden and mortality, a rethink about the optimal drug doses and duration may be required. Summary The high mortality and morbidity from TBP despite use of anti-tuberculous drugs call for researches targeting hostdirected immunological determinants of treatment outcome. There is also a need for the identification of steps in clinical management where interventions are needed to improve outcomes. Keywords Tuberculous pericarditis . Mycobacterium tuberculosis Case VignetteA 33-year-old woman, HIV positive with a CD4 count of 21 cells/μL, presented with weight loss, night sweats, and shortness of breath. At presentation, recorded examination findings were temperature of 35.5°C, peripheral oxygen saturation 100%, respiratory rate 22/min, heart rate 112 beats/ min, blood pressure 106/62 mmHg with a pulsus paradoxus of 16 mmHg, and distant heart sounds. Her admission electrocardiogram (ECG), chest radiograph (CXR), and point of This article is part of the Topical Collection on Pericardial Disease

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“…The manifestations of tuberculous involvement of the pericardium may include pericarditis, pericardial effusions with or without associated effusive-constrictive syndromes and progression to calcified pericardial constriction. 24,25,26…”

Section: Pericardial Diseasementioning

confidence: 99%

Review of cardiovascular magnetic resonance in human immunodeficiency virus-associated cardiovascular disease

et al. 2017

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Despite ongoing advances in the treatment of patients with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), they remain a major global public health concern conferring an increased risk of morbidity and mortality in affected individuals. This is, in part, because of the widespread dysfunction imposed by HIV and its treatment on the cardiovascular system, including the myocardium, valvular apparatus, pericardium and coronary, pulmonary and peripheral vasculature. In recent times, cardiovascular magnetic resonance (CMR) imaging has emerged as the gold standard tool for assessment of a variety of indications, allowing comprehensive characterisation of functional, morphological, metabolic and haemodynamic sequelae of several cardiovascular pathologies. Furthermore, continued advancement in imaging techniques has yielded novel insights into the underlying pathophysiology and guides future therapeutic strategies. In this article, we review the various clinical phenotypes of HIV-associated cardiovascular disease and highlight the utility of CMR in their assessment.

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Cardiovascular magnetic resonance characterisation of pericardial and myocardial involvement in patients with tuberculous pericardial constriction with and without HIV co-infection

Cited by 3 publications

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HIV-Associated Cardiovascular Disease

HIV-Associated Cardiovascular Disease

Diagnosis and Management of Tuberculous Pericarditis: What Is New?

Review of cardiovascular magnetic resonance in human immunodeficiency virus-associated cardiovascular disease

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