Determinants of Left Ventricular Hypertrophy and Diastolic Dysfunction in an HIV Clinical Cohort

Objective

The aim of this work was to investigate determinants of structural myocardial abnormalities in persons living with human immunodeficiency virus (PLWH).

Methods and Results

We reviewed archived transthoracic echocardiograms (TTEs) performed on PLWH at Duke University Medical Center from 2001 to 2012. The primary outcomes were presence of left ventricular hypertrophy (LVH) or diastolic dysfunction (DD). TTEs for 498 human immunodeficiency virus–infected persons were reviewed (median age 44 years, 38% female, 72% black, 34% with hypertension, 15% with diabetes). Among those with usable images, LVH was detected in 174 of 473 persons (37%) according to LV mass criteria and in 99 of 322 persons (31%) according to American Society of Echocardiography LV mass index criteria. Definite DD was detected in 18 of 224 persons (8%). LVH was more common in PLWH with a CD4 count ≤ 200 cells/mm³ proximal to TTE (adjusted OR 1.68, 95% CI 1.08–2.62), CD4 nadir ≤ 200 cells/mm³ (adjusted OR 1.63, 95% CI 1.04–2.54) and less common in persons with viral suppression (OR 0.46, 95% CI 0.27–0.80). Lower CD4 nadirs (P?=?.002) and proximal CD4 counts (P?=?.002) were also associated with DD.

Conclusions

Persons with a history of advanced human immunodeficiency virus–associated immune suppression are at higher risk of LVH and DD than infected persons with preserved immune function.