The Association of HIV Infection with Left Ventricular Mass/Hypertrophy

Abstract

Left ventricular hypertrophy (LVH) is an independent predictor of major cardiovascular events. Cardiovascular risk is increased among human immunodeficiency virus (HIV)-infected patients. To assess LV mass/hypertrophy in HIV infection, 654 women enrolled in the Women's Interagency HIV Study underwent transthoracic echocardiography. There were 454 HIV-infected and 200 uninfected women, mean age 40.8 ± 9.3 years. LV mass/height2.7 was similar between the HIV-infected and the HIV-uninfected groups (41.4 ± 11.1 vs. 39.9 ± 10.3 g/h2.7; p = 0.37). The prevalence of LVH was similar between the two groups (LVH by LV mass/height2.7 criteria 15.0% vs. 13.0%, p = 0.29). Relative wall thickness (RWT), defined as the ratio of LV wall thickness to cavity diameter, was also similar between the HIV-infected and HIV-uninfected groups (0.36 ± 0.05 vs. 0.37 ± 0.06, p = 0.16). On multiple linear regression analysis adjusting for age, W/H ratio, triceps skinfold thickness, systolic/diastolic BP, diabetes, hypertension and dyslipidemia; HIV status (b = 2.08, p = 0.02, CI 0.27–3.88); weight (b per kg = 0.15, p<0.01, CI 0.08–0.22); and smoking duration (b per one-year increase = 0.08, p = 0.03, CI 0.01–0.16) were independent correlates of LV mass/height2.7 (Model R2 = 0.20, p<0.001). Weight (aOR = 1.04, CI 1.01–1.06) and smoking duration (aOR = 1.03, CI 1.01–1.06) were independent correlates of LVH. Being HIV negative, increased age, increased triceps skinfold thickness, and higher W/H ratio were independent correlates of higher RWT. Among HIV-infected women, higher LV mass was not associated with a history of AIDS-defining illness, nadir CD4+ count <200 cells/μl, or with the duration of highly active antiretroviral therapy (HAART). Women taking NRTIs had higher LV mass. Higher RWT was associated with current CD4+ count. In conclusion, HIV infection is associated with greater LV mass but not with a higher prevalence of LVH. Among HIV-infected women, RWT, but not LV mass, is associated with the degree of immunosuppression.

Left ventricular remodelling in asymptomatic HIV infection on chronic HAART: comparison between hypertensive and normotensive subjects with and without HIV infection

“…[17][18][19][20][21][22][23][24] In fact, taken together these studies obtained dissimilar results: if preclinical diastolic dysfunction is often reported, LV mass has been found increased, normal or even reduced and LV systolic function normal or, in few studies, impaired. 38 Actually, these studies can hardly be compared with each other and with our study, mainly because of great differences in such relevant issues as methods employed (that is, clinic BP values, absolute values of LV mass instead of values indexed for body surface area or height ) and patients characteristics (asymptomatic HIV þ patients, HIV þ patients with various degrees of malnutrition, AIDS patients, mixed groups of asymptomatic and symptomatic HIV þ patients, only women, only African or African-American subjects).…”

“…Moreover in some studies HIV þ patients and controls were significantly different with regard to smoking habit, BMI and/or BP values; often no information was available about BP profile or antihypertensive and antidyslipidemic treatment. [17][18][19][20][21][22][23][24] It is beyond the scope of this cross-sectional study to deal with the pathophysiologic mechanisms linking HIV infection and chronic HAART to LV remodelling. However, we can hypothesized that, besides other mechanisms like myocardial viral infection, direct myocardial mitochondrial toxicity by antiviral drugs and chronic inflammation, a relevant role could be played by metabolic complications.…”

“…Previous studies [17][18][19][20][21][22][23][24] on LV characteristics in HIV þ patients reached dissimilar results, probably because of great differences in study design, methods and patients characteristics.…”

Echocardiographic Abnormalities and Associated Factors in a Cohort of Asymptomatic HIV-Infected Patients

“…5 In the specific case of LV hypertrophy the data are contradictory, with some authors defending a lower ventricular mass in HIV-infected patients 6 whereas others suggest the opposite. 7,8 LV hypertrophy and LV diastolic dysfunction are related to the development of heart failure in asymptomatic patients and have an important impact on morbidity and mortality in the general population. 9 This might also be the case in persons with HIV.…”

Refining Patterns of Left Ventricular Hypertrophy Using Cardiac MRI

“…23 There has been investigation into the relationship between geometry and outcome 24 -26 and studies of the physiology of concentric remodeling, which has been shown to be associated with low-tonormal cardiac output and reduced midwall shortening, markers of subtly impaired systolic function. 27 Similar considerations of geometry have provided insight into LV structure and function in heart failure.…”