Kearney Debra L, Perez-Atayde Antonio R, Easley Kirk A, Bowles Neil E, Bricker J Timothy, Colan Steven D, Kaplan Samuel, Lai Wyman W, Lipshultz Steven E, Moodie Douglas S, Sopko George, Starc Thomas J, Towbin Jeffrey A
Department of Pathology, Baylor College of Medicine, Houston, TX 77030, USA.
Cardiovasc Pathol. 2003 May-Jun;12(3):140-8. doi: 10.1016/s1054-8807(03)00035-8.
Cardiomegaly, seen postmortem in over 50% of HIV-infected children, may occur in the absence of clinical or histopathologic cardiac disease. Premortem echocardiography has also demonstrated clinical and subclinical cardiac disease, including increased left ventricular mass (LVM) and functional abnormalities. No studies have compared these echocardiographic measures of heart size and function with postmortem findings in this population. We sought to determine the postmortem prevalence, clinicopathologic relationships and importance of cardiomegaly in HIV-infected children.
We reviewed clinical and postmortem cardiac findings in 30 HIV-infected children who were part of the Prospective P(2)C(2) HIV Study. Postmortem heart weight was compared with clinical measures of heart size and function, with cardiac pathology and with clinical measures reflecting chronic effects of HIV disease.
Postmortem cardiomegaly (heart weight z score >/=2) was identified in 53% of the children. Children with cardiomegaly had increased LVM, increased heart rate, more frequent clinical chronic heart disease and a higher prevalence of postmortem pericardial effusions compared to children without cardiomegaly (P</=.05). The association with LV end-diastolic dimension (LVEDD) did not reach statistical significance (P=.08). No association was found with LV posterior wall thickness (LVPWT), CD4(+) T-cell counts, HIV-1 viral load, hemoglobin, encephalopathy, myocardial histology or myocardial organisms.
Postmortem cardiomegaly was associated with echocardiographic measures of increased LVM. The pathogenesis appears not to be related to chronic anemia, HIV viral load, the degree of immune suppression or encephalopathy. Autonomic dysregulation, reflected by chronically increased heart rate, may be of pathoetiologic significance.
心脏肿大在超过50%的HIV感染儿童尸检中可见，可能在无临床或组织病理学心脏病的情况下出现。生前超声心动图也已证实存在临床和亚临床心脏病，包括左心室质量（LVM）增加和功能异常。尚无研究将这些心脏大小和功能的超声心动图测量结果与该人群的尸检结果进行比较。我们试图确定HIV感染儿童心脏肿大的尸检患病率、临床病理关系及重要性。
我们回顾了30名HIV感染儿童的临床和尸检心脏检查结果，这些儿童是前瞻性P(2)C(2) HIV研究的一部分。将尸检心脏重量与心脏大小和功能的临床测量结果、心脏病理学以及反映HIV疾病慢性影响的临床测量结果进行比较。
53%的儿童被确定存在尸检心脏肿大（心脏重量z评分≥2）。与无心脏肿大的儿童相比，有心脏肿大的儿童LVM增加、心率加快、临床慢性心脏病更常见，尸检心包积液患病率更高（P≤0.05）。与左心室舒张末期内径（LVEDD）的关联未达到统计学显著性（P = 0.08）。未发现与左心室后壁厚度（LVPWT）、CD4(+) T细胞计数、HIV-1病毒载量、血红蛋白、脑病、心肌组织学或心肌病原体有关联。
尸检心脏肿大与LVM增加的超声心动图测量结果相关。其发病机制似乎与慢性贫血、HIV病毒载量、免疫抑制程度或脑病无关。心率长期增加所反映的自主神经调节异常可能具有病因学意义。
