Division of Cardiology, San Francisco General Hospital, San Francisco, CA 94110, USA.
Circ Heart Fail. 2010 Jan;3(1):132-9. doi: 10.1161/CIRCHEARTFAILURE.109.854943. Epub 2009 Nov 20.
Patients with HIV have increased risk for cardiovascular disease, but the underlying mechanisms remain unknown. The purpose of this study was to determine the prevalence of echocardiographic abnormalities among asymptomatic HIV-infected individuals compared with HIV-uninfected individuals. Methods/Results- We performed echocardiography in 196 HIV-infected adults and 52 controls. Left ventricular ejection fraction, left ventricular mass indexed to the body surface area, and diastolic function were assessed according to American Society of Echocardiography standards. Left ventricular mass index was higher in HIV-infected patients (77.2 g/m(2) in patients with HIV versus 66.5 g/m(2) in controls, P<0.0001). Left ventricular ejection fraction was similar in both groups. Eight (4%) of the patients with HIV had evidence of left ventricular systolic dysfunction (defined as an EF <50%) versus none of the controls; 97 (50%) had mild diastolic dysfunction compared with 29% of the HIV-uninfected subjects (P=0.008). After adjustment for hypertension and race, HIV-infected participants had a mean 8 g/m(2) larger left ventricular mass index compared with controls (P=0.001). Higher left ventricular mass index was independently associated with lower nadir CD4 T-cell count, suggesting that immunodeficiency may play a role in this process. After adjustment for age and traditional risk factors, patients with HIV had a 2.4 greater odds of having diastolic dysfunction as compared with controls (P=0.019).
HIV-infected patients had a higher prevalence of diastolic dysfunction and higher left ventricular mass index compared with controls. These differences were not readily explained by differences in traditional risk factors and were independently associated with HIV infection. These results suggest that contemporary asymptomatic patients with HIV manifest mild functional and morphological cardiac abnormalities, which are independently associated with HIV infection.
HIV 感染者罹患心血管疾病的风险增加，但具体机制尚不清楚。本研究旨在确定与 HIV 未感染者相比，无症状 HIV 感染者中超声心动图异常的发生率。
方法/结果：我们对 196 例 HIV 感染者和 52 例对照者进行了超声心动图检查。根据美国超声心动图学会标准评估左心室射血分数、左心室质量指数（左心室质量/体表面积）和舒张功能。HIV 感染者的左心室质量指数更高（HIV 感染者为 77.2 g/m2，对照组为 66.5 g/m2，P<0.0001）。两组左心室射血分数相似。8 例（4%）HIV 感染者存在左心室收缩功能障碍（定义为 EF<50%），而对照组无此情况；97 例（50%）存在轻度舒张功能障碍，而 HIV 未感染者为 29%（P=0.008）。调整高血压和种族因素后，HIV 感染者的左心室质量指数比对照组平均大 8 g/m2（P=0.001）。左心室质量指数较高与最低 CD4 T 细胞计数降低独立相关，提示免疫缺陷可能在此过程中发挥作用。调整年龄和传统危险因素后，与对照组相比，HIV 感染者发生舒张功能障碍的几率高 2.4 倍（P=0.019）。
与对照组相比，HIV 感染者舒张功能障碍和左心室质量指数更高的发生率更高。这些差异不能用传统危险因素的差异来很好地解释，并且与 HIV 感染独立相关。这些结果表明，当代无症状 HIV 感染者表现出轻微的功能性和形态学心脏异常，与 HIV 感染独立相关。
