Simon Marc A, Lacomis Christopher D, George M Patricia, Kessinger Cathy, Weinman Renee, McMahon Deborah, Gladwin Mark T, Champion Hunter C, Morris Alison
Heart and Vascular Institute, University of Pittsburgh.
Department of Bioengineering, University of Pittsburgh.
J Card Fail. 2014 Jun;20(6):414-421. doi: 10.1016/j.cardfail.2014.03.009. Epub 2014 Apr 12.
HIV-infected individuals are at increased risk for pulmonary hypertension and cardiomyopathy, portending a poor prognosis. Right ventricular (RV) dysfunction is associated with worse outcomes in these conditions, yet its prevalence is poorly defined in HIV. We sought to determine the prevalence of RV dysfunction in an outpatient HIV cohort.
Echocardiograms were evaluated from 104 HIV-infected adults. Measurements included estimated pulmonary arterial systolic pressure (PASP) and several measures of RV function, including tricuspid annular plane systolic excursion (TAPSE), RV longitudinal myocardial strain (RVLMS), RV fractional area change (RVFAC), and myocardial performance index (MPI).
Sixteen subjects (15%) had PASP >35 mm Hg, yet RV function did not differ significantly from those with normal estimated PASP. RV dysfunction defined by RVFAC <35% occurred in 11%. RVLMS had a median value of -27.3%, and individuals below the median had lower TAPSE but no differences in left ventricular ejection fraction (LVEF), PASP, or other measures. Dyspnea was associated with the lowest quintile of RVLMS (≥-21.05%). There were 6 subjects with LVEF <50%, and these individuals had lower TAPSE but no differences in PASP or other RV functional measures.
RV dysfunction was common as estimated PASP >35 mm Hg and LV dysfunction, but these findings did not cosegregate. RV dysfunction in HIV-infected individuals may be a separate entity from LV/global cardiomyopathy or pulmonary hypertension and deserves further study.
HIV感染者患肺动脉高压和心肌病的风险增加，预后较差。右心室（RV）功能障碍在这些情况下与更差的预后相关，但在HIV患者中其患病率尚不明确。我们试图确定门诊HIV队列中RV功能障碍的患病率。
对104名HIV感染成人的超声心动图进行评估。测量指标包括估计的肺动脉收缩压（PASP）和几种RV功能指标，包括三尖瓣环平面收缩期位移（TAPSE）、RV纵向心肌应变（RVLMS）、RV面积变化分数（RVFAC）和心肌性能指数（MPI）。
16名受试者（15%）的PASP>35mmHg，但RV功能与估计PASP正常者相比无显著差异。RVFAC<35%定义的RV功能障碍发生率为11%。RVLMS的中位数为-27.3%，低于中位数的个体TAPSE较低，但左心室射血分数（LVEF）、PASP或其他指标无差异。呼吸困难与RVLMS最低五分位数（≥-21.05%）相关。有6名受试者LVEF<50%，这些个体TAPSE较低，但PASP或其他RV功能指标无差异。
RV功能障碍常见于估计PASP>35mmHg和左心室功能障碍时，但这些发现并未共同出现。HIV感染者的RV功能障碍可能是与左心室/整体心肌病或肺动脉高压不同的实体，值得进一步研究。
