aDivision of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio bDivision of Cardiovascular Medicine, University of Maryland Baltimore, Maryland cDivision of Infectious Diseases and Institute of Human Virology dHouston Methodist DeBakey Heart & Vascular Center, Houston, Texas eDivision of Infectious Disease, Cleveland Medical Center, Cleveland, Ohio fThe Ohio State University, Columbus, Ohio, USA.
J Cardiovasc Med (Hagerstown). 2017 Nov;18(11):888-896. doi: 10.2459/JCM.0000000000000575.
Pulmonary arterial hypertension (PAH) is a potentially serious cause of dyspnea and exercise limitation in patients with HIV infection. In this trial, we propose using exercise MRI in conjunction with cardiopulmonary testing to delineate PAH from other causes of cardiovascular dysfunction, identify individuals with exercise-induced PAH who are at high risk of developing resting PAH, and provide longitudinal estimates of progression of PAH and right ventricular function.
In this prospective observational study, HIV patients with dyspnea and exercise limitation in the absence of identifiable causes and those who meet the inclusion criteria will be enrolled based on resting pulmonary artery pressure (≤ or >40 mmHg) on a screening echocardiogram and exercise limitation on the Modified Medical Research Council dyspnea scale. Patients without evidence of resting PAH will be enrolled into both rest and exercise MRI and cardiopulmonary testing protocol, whereas patients with evidence of PAH on resting echocardiograms will undergo only resting cardiac MRI studies to evaluate right ventricular function and fibrosis. Both patient subgroups will be followed for 24 months to obtain longitudinal progression of the disease. In a sub-study, we will further analyze inflammatory variables that may predict these changes, thus allowing early identification of these patients.
This trial will be the first study to provide an understanding of the mechanisms underpinning the functional deterioration of the right ventricle in patients with HIV and will impart insight into the immune mediators of PAH progression and right ventricular functional deterioration in patients with HIV-PAH.
肺动脉高压（PAH）是 HIV 感染患者呼吸困难和运动受限的一个潜在严重原因。在这项试验中，我们建议使用运动 MRI 结合心肺测试，以从心血管功能障碍的其他原因中描绘 PAH，识别出患有运动诱导性 PAH 的个体，这些个体有发展为静息性 PAH 的高风险，并提供 PAH 和右心室功能进展的纵向估计。
在这项前瞻性观察性研究中，将招募在无明显原因的情况下出现呼吸困难和运动受限且符合筛选超声心动图上静息肺动脉压（≤或>40mmHg）和改良医学研究委员会呼吸困难量表上运动受限标准的 HIV 患者。没有静息性 PAH 证据的患者将被纳入静息和运动 MRI 以及心肺测试方案，而在静息超声心动图上有 PAH 证据的患者仅将进行静息心脏 MRI 研究，以评估右心室功能和纤维化。这两个患者亚组将被随访 24 个月，以获得疾病的纵向进展。在一个子研究中，我们将进一步分析可能预测这些变化的炎症变量，从而能够早期识别这些患者。
这项试验将是首次研究提供对 HIV 患者右心室功能恶化的潜在机制的理解，并深入了解 HIV-PAH 患者中 PAH 进展和右心室功能恶化的免疫介质。
