Long-term subclinical cardiac damage in people living with human inmunodeficiency virus.
J Gomez Diego, R Gascuena Rubia, M Cervero Jimenez, C De Blas Ruiz, B Jimenez Azzaoui, T Morales Martinez, G E Candela Ganoza, C G Carrasco Munoz, R Ruesgas Escario, M Fernandez Ustoa, A Esteban-Fernandez, I Fernandez RozasAbstract
Introduction
Human immunodeficiency virus infection remains a major global health challenge. People living with HIV are twice as likely to develop cardiovascular disease. Myocardial work is a novel echocardiographic technique that assesses global work index and global work efficiency of the left ventricle, enabling earlier detection of subclinical myocardial dysfunction.
Material and methods
We conducted a cross-sectional study of patients with long-standing HIV infection without previous cardiovascular disease, aiming to evaluate the prevalence of subclinical cardiac dysfunction determined by an impaired global myocardial work efficiency and studied its determinants by linear regression.
Results
110 HIV patients (78.2% men) were included, median age 53.3 years and median time since diagnosis of 20.5 years. Echocardiographic measurements were compared with matched control participants. HIV patients showed significantly lower values of global longitudinal strain of the left ventricle, right ventricle free wall and left atrial reservoir, although absolute values remained within normal limits. HIV group had consistently reduced global work efficiency values (<92%) which was related by univariate analysis to age, diabetes, SCORE2, time from diagnosis, long corrected QT interval, QRS Interval duration, CD4 count nadir, initial and maximum viral load and exposure to didanosine. After adjustment by SCORE2 and QRS duration, global work efficiency reduction depended on maximum viral load.
Conclusions
Subclinical myocardial disfunction is prevalent in long standing HIV infection. Global work efficiency is a very sensitive parameter for detection, even in patients with preserved left ventricular ejection fraction and normal global longitudinal strain values, and is related to maximum viral load.