Cardiac Magnetic Resonance Reveals Signs of Subclinical Myocardial Inflammation in Asymptomatic HIV-Infected Patients. (March 2016)

• Record Type: Journal Article
• Authors: Luetkens, Julian A.; Doerner, Jonas; Schwarze-Zander, Carolynne; Wasmuth, Jan-Christian; Boesecke, Christoph; Sprinkart, Alois M.; Schmeel, Frederic C.; Homsi, Rami; Gieseke, Juergen; Schild, Hans H.; Rockstroh, Jürgen K.; Naehle, Claas P.
• Is Part Of: Circulation. Volume 9:Number 3(2016)
• Publication Date: 2016-03
• Subjects: cardiovascular diseases -- HIV infections -- inflammation -- magnetic resonance imaging -- myocarditis; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.1075405
• DOI: 10.1161/CIRCIMAGING.115.004091
• Languages: English
• ISSNs: 1941-9651

Abstract

Abstract : Background—: People living with chronic HIV infection are at an increased risk for cardiovascular disease. With this study, we aimed to determine the extent of cardiovascular involvement in asymptomatic HIV-infected patients by a comprehensive cardiac magnetic resonance (CMR) approach. Methods and Results—: Asymptomatic patients with chronic HIV infection undergoing combination antiretroviral therapy (n=28) and control subjects (n=22) underwent CMR. HIV-infected patients were successfully controlled for the disease with a consistent plasma viremia of <200 copies/mL (mean CD4 + -cell count, 475.1±307.9 cells/μL). CMR protocol allowed for the determination of cardiac function, myocardial inflammation, myocardial fibrosis, aortic stiffness, and pericardial fat volume. When compared with healthy controls, HIV-infected patients showed alterations in left ventricular function as demonstrated by a lower ejection fraction (60.9±7.1% versus 65.2±5.5%; P =0.023) and lower global peak systolic longitudinal and circumferential strain values (longitudinal strain, −17.7±3.4% versus −20.2±3.2%, circumferential strain, −21.2±4.6% versus −24.7±5.1%; P <0.001, respectively). CMR parameters indicating myocardial inflammation were elevated in HIV-infected patients (native T1 relaxation times, 1128.3±53.4 ms versus 1086.5±54.5 ms; P =0.009; relative T2 signal intensity ratio, 1.6±0.3 versus 1.4±0.3; P =0.046; early gadolinium enhancement ratio, 3.1±1.2 versus 2.1±0.6; P =0.003). Myocardial fibrosis, predominantly at the subepicardium of the midventricular and basal inferolateral wall, was prevalent in 82.1% of HIV-infected patients, but only in 27.3% of healthy controls ( P <0.001). Conclusions—: Comprehensive CMR revealed a high burden of cardiovascular disease in asymptomatic HIV-infected patients. Subclinical myocardial inflammation as detected by CMR may be a potential precursor of the increased cardiovascular morbidity and mortality observed in patients with chronic HIV infection. Abstract : Supplemental Digital Content is available in the text.