Abstract
Objectives: To investigate the subclinical imaging changes in terms of myocardial inflammation and fibrosis and to explore the risk factors associated with myocardial fibrosis by cardiac magnetic resonance (CMR) approach in a Chinese HIV/AIDS cohort.Methods: We evaluated myocardial function (cine), myocardial inflammation (T1, T2), and myocardial fibrosis (through extracellular volume fraction [ECV] and late gadolinium enhancement [LGE]) by a multiparametric CMR scan protocol in a total of 68 participants, including 47 HIV-infected individuals, who were divided into two groups: asymptomatic HIV (HIV+) (n = 30), and acquired immunodeficiency syndrome (AIDS) (n = 17), and 21 healthy controls.Results: HIV-infected patients had lower left (55.3 ± 6.5 vs. 63.0 ± 7.9%, P < 0.001) and right ventricular systolic function (35.9 ± 15.7 vs. 50.8 ± 9.3%, P < 0.001). Radial systolic strain (30.7 ± 9.3 vs. 39.3 ± 9.4%, P = 0.001), circumferential systolic strain (−17.5 ± 2.6 vs. −19.4 ± 2.7%, P = 0.008), and longitudinal systolic strain (−9.4 ± 5.7 vs. −12.8 ± 3.1%, P = 0.012) were also decreased in HIV. Native T1 relaxation time (1,337.2 ± 70.2 vs. 1,249.5 ± 47.0 ms, P < 0.001), ECV value (33.5 ± 6.2 vs. 28.5 ± 2.9 ms, P = 0.026), and T2 relaxation time (45.2 ± 3.5 vs. 42.0 ± 2.6 ms, P = 0.001) were higher in HIV-infected patients compared with controls. Myocardial fibrosis, predominantly in the mid-inferior wall, was detected in 24.4% of the HIV-infected patients. HIV+ had a significantly lower value of ECV [29.1 (26.1, 31.8) vs. 35.2 (31.8, 41.9) %, P < 0.001] and frequency of LGE [3/25 (8%) vs. 7/16 (43.8%), P = 0.014)] compared with AIDS. AIDS was associated with myocardial fibrosis.Conclusions: HIV-infected patients were associated with changes in myocardial function and higher rates of subclinical myocardial inflammation and fibrosis, which were more abnormal with greater severity of the disease. AIDS was associated with myocardial fibrosis, where the observations supported earlier initiation of antiretroviral therapy in the Chinese HIV/AIDS cohort.
Highlights
Cardiac abnormalities were believed to be prevalent in HIV infected patients [1, 2]
Our study aimed to explore the cardiac involvement in Chinese HIV/AIDS patients by cardiovascular magnetic resonance (CMR) while determining the risk factors associated between the HIV-related clinical parameters and myocardial fibrosis
There were no significant differences in left ventricular eject fraction (LVEF), Left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular cardiac output (LVCO), LVEDVi, LVESVi, RVEF, right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV), right ventricular cardiac output (RVCO), RVEDVi, RVESVi between HIV+ and AIDS subjects, nor were there significant differences in GRS, GCS, and GLS
Summary
Cardiac abnormalities were believed to be prevalent in HIV infected patients [1, 2]. Even though the introduction of antiretroviral therapy (ART) has altered the cardiovascular manifestations, HIV-infected patients are still at an increased risk for cardiovascular disease for the high prevalence of traditional cardiovascular risk factors and concurrent metabolic changes induced by ART [4]. Previous studies [5] demonstrated that a major percentage of HIV infected patients have abnormal ECG findings, and echocardiography studies [6, 7] found that patients with asymptomatic HIV infection noted a relatively low frequency of left ventricular dysfunction and other abnormalities when compared with patients in the later stage of the disease. Only a few autopsy studies had been conducted to address myocardial abnormalities in HIV infection [9]
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