Echocardiography Assessment of Cardiac Function in Adults Living with HIV: A Speckle Tracking Study in the Era of Antiretroviral Therapy

Abstract

Adults living with HIV (human immunodeficiency virus) infection (ALHIV) have high rates of cardiovascular events. New approaches are needed to detect subclinical cardiac dysfunction. We used conventional and speckle tracking echocardiography to investigate whether ALHIV display latent cardiac dysfunction. We analyzed 85 young subjects with HIV infection and free from cardiovascular risk factors (31 ± 4 years) and 80 matched healthy volunteers. We measured left ventricular (LV) layered global longitudinal strain, circumferential strain, peak longitudinal strain in the reservoir and contraction phases of the left atrium (LASr respectively LASct). In the HIV group, LV ejection fraction and s’ TDI (tissue doppler imaging) were slightly lower but still in the normal ranges. Layered longitudinal strain showed no significant difference, whereas circumferential global strain was significantly lower in the HIV group (−20.3 ± 3.9 vs. −22.3 ± 3.0, p < 0.001). LASr (34.3% ± 7.3% vs. 38.0% ± 6.9%, p < 0.001) was also lower in ALHIV and multivariate analysis showed that age (β = −0.737, p = 0.01) and infection duration (β = −0.221, p = 0.02) were independently associated with LASr. In the absence of cardiovascular risk factors, adults living with HIV display normal LV systolic function. Left atrial reservoir strain, is, however, decreased and suggests early diastolic dysfunction.

Assessment of subclinical cardiac dysfunction by speckle-tracking echocardiography among people living with human immunodeficiency virus

“…These values were relatively reduced compared to those in the healthy Asian subjects, i.e., −22.8%, −20.0%, and −17.5% at endo-, mid-, and epi-myocardium, respectively (24). This finding was consistent with previous studies, demonstrating the asymptomatic reduction in myocardial deformation in PLWH even though they did not have CVDs (15)(16)(17)(18)(19). In addition, Mirea et al and our study have both shown that the strain values decrease from the endocardium to the epicardium (19).…”

“…This finding was consistent with previous studies, demonstrating the asymptomatic reduction in myocardial deformation in PLWH even though they did not have CVDs ( 15 – 19 ). In addition, Mirea et al and our study have both shown that the strain values decrease from the endocardium to the epicardium ( 19 ). The differences in layer-specific strain values may be due to the distribution of fiber angles of human heart, and the pattern of strain reduction may aid in distinguishing the determinant of myocardial impairment ( 25 ).…”

“…Previous STE studies showed reduced myocardial strains in PLWH compared to general populations, even given normal conventional echocardiography measurements. These findings provide supporting data on STE's capability in detecting subclinical myocardial abnormality in PLWH ( 14 – 19 ). Nevertheless, the small sample size and limited study population may influence the robustness of evidence to generalize the application of STE.…”

“…The mechanism underlying HIV-associated cardiomyopathy is typically multifactorial, resulting from direct HIV toxicity, opportunity infections, autoimmunity, severe immunosuppression, or nutritional deficiencies ( 23 ). Previous studies have shown that PLWH have a reduced LVGLS even in the absence of other risk factors and comorbidities ( 12 – 19 ). In our analysis, PLWH's layer-specific LV strain was −20.8%, −18.6%, and −16.6% at endo-, mid-, and epi-myocardium, respectively.…”