Diastolic Dysfunction in Patients With Human Immunodeficiency Virus Receiving Antiretroviral Therapy: Results From the CHART Study |
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| Affiliation: | 1. Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi;2. Duke Clinical Research Institute, Durham, North Carolina;3. Division of Cardiology, Duke University School of Medicine, Durham, North Carolina;4. Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois;5. Division of Cardiology, Stony Brook University, Stony Brook, New York;6. Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut;7. Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland;8. Department of Medicine, University of California San Francisco and San Francisco Department of Veterans Administration, San Francisco, California;9. Division of Cardiology, University of California San Francisco, San Francisco, California;10. TIMI Study Group, Department of Medicine, Brigham and Women''s Hospital, Harvard Medical School, Boston, Massachusetts;1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota;2. Duke Clinical Research Institute, Durham, North Carolina;3. Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts;4. Division of Cardiology, Northwestern University; Chicago, Illinois;5. Division of Cardiology, Duke University, Durham, North Carolina;6. Division of Cardiology, Vanderbilt University, Nashville, Tennesee;1. Center for Medicine, Institute for Exercise- and Occupational Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Germany;2. Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany |
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| Abstract: | BackgroundDiastolic dysfunction (DD) is common and occurs at an earlier age among human immunodeficiency virus-infected (HIV+) individuals, but the mechanisms and consequences of DD among HIV+ individuals are unclear.Methods and ResultsThe Characterization of Heart Function on Antiretroviral Therapy (CHART) study was a multicenter cross-sectional case-control study of treated and virally suppressed HIV+ individuals with (DD+) and without DD (DD−). All patients had normal ejection fraction (>50%), no significant valvular disease, and no history of coronary revascularization or persistent atrial fibrillation. Overall, 94 DD+ and 101 DD− patients were included. DD+ patients were older with higher body mass index (BMI) and more likely to have hypertension, renal dysfunction, and dyslipidemia. Groups were similar with respect to sex, race, CD4 count, and HIV RNA copies. N-terminal pro-B-type natriuretic peptide levels (median 36 [23, 85] vs 26 [12, 49] pg/mL, P < .01) and high-sensitivity troponin I (3.6 [2.6, 5.1] vs 2.5 [1.8, 3.5] pg/mL, P < .01) were higher among DD+ patients. The latter had similar left atrial size, but increased stiffness (conduit strain: 23.5 [17.5, 36.9] vs 30.0 [22.9, 37.0], P < .01) and impaired relaxation (reservoir strain: 39.7 [32.0, 58.0] vs 45.9 [37.0, 60.6], P = .04). On cardiac magnetic resonance, the prevalence of focal fibrosis was higher among DD+ patients (19.0% vs 5.3%, P < .01). DD+ patients demonstrated higher levels of carboxyl-terminal telopeptide of collagen type I (P = .04), and trends toward higher interleukin-6 and oxidized low-density lipoprotein levels (P ≤ .08). Kansas City Cardiomyopathy Questionnaire physical limitation (87.1±21.4 vs 93.1±18.1, P = .01) and symptom frequency scores were lower among DD+ patients (86.0±21.5 vs 92.5±16.8, P = .01).ConclusionsIn this contemporary HIV+ population receiving antiretroviral therapy, DD was associated with multiple alterations in cardiac structure and function, including myocardial fibrosis and left atrial abnormalities, and worse quality of life. Further studies are needed to assess longitudinal changes in these parameters and their potential as therapeutic targets to prevent progressive cardiac remodeling and dysfunction in HIV. |
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