Left Ventricular Global Longitudinal Strain and Ventricular Repolarization in People with HIV: A Comparative Cross-Sectional Study

Background and Objectives: Subclinical myocardial deformation and ventricular repolarization abnormalities may occur in people with HIV (PWH) despite preserved left ventricular ejection fraction (LVEF). We evaluated left ventricular global longitudinal strain (LV GLS) and Tpeak-to-end (Tp-e)-based repolarization indices in PWH and examined their within-person relationship. Materials and Methods: This prospective comparative cross-sectional study included 25 PWH and 47 HIV-negative reference participants consecutively recruited from outpatient clinics. All participants were in sinus rhythm and had LVEF ≥50%. Conventional and speckle-tracking echocardiography and 12-lead electrocardiography were performed. Multivariable linear regression assessed associations of HIV status with LV GLS, Tp-e interval, and Tp-e/QTc ratio after adjustment for age, sex, current smoking, and hyperlipidemia. Within-PWH associations were assessed using Spearman correlation with multiplicity adjustment. Results: PWH had less negative LV GLS than reference participants (−17.1% vs. −19.0%; p < 0.001), longer Tp-e intervals (74 vs. 72 ms; p = 0.001), and higher Tp-e/QTc ratios (0.185 vs. 0.173; p < 0.001). HIV status remained associated with LV GLS (B = 2.472 percentage points, 95% CI 1.672–3.272), Tp-e (B = 4.347 ms, 95% CI 2.286–6.408), and Tp-e/QTc (B = 0.013, 95% CI 0.009–0.017; all p < 0.001). Within PWH, LV GLS was not significantly correlated with Tp-e or Tp-e/QTc. Conclusions: PWH with preserved LVEF showed less negative LV GLS and less favorable Tp-e-based repolarization indices than HIV-negative reference participants. These cross-sectional findings do not establish causal, prognostic, or screening implications, and the non-significant within-PWH correlations do not exclude potentially relevant associations. Larger longitudinal studies are warranted.