Paediatric Cardiology Service, Paediatric Hospital, Coimbra Hospital and Universitary Centre, Avenida Afonso Romão, 3000-602, Coimbra, Portugal.
Coimbra Institute for Clinical and Biomedical Researh (iCBR) - Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
Eur J Pediatr. 2020 Mar;179(3):395-404. doi: 10.1007/s00431-019-03477-7. Epub 2019 Nov 25.
HIV-uninfected children exposed prenatally to the virus and to prophylactic antiretroviral therapy are at an uncertain risk of long-term myocardial dysfunction. This study aimed to analyse the structure and function of their ventricles and to identify potential screening tools for this at-risk population. One hundred and fifteen children (77 exposed vs 38 controls) aged between 2.7 and 16.2 years were included. An echocardiographic study was performed where both ventricles' dimensions and systolic functions were evaluated. In the left ventricle, parameters related to diastolic function were also analysed. Tissue Doppler values were determined in the basal state and after passive leg raising. Serologic analysis of amino-terminal pro-B-type natriuretic peptide (NT-proBNP) was carried out. The two groups had identical ventricular sizes and left ventricular diastolic functions. However, contractility assessed by myocardial peak systolic velocity was significantly inferior in the exposed group. These systolic echocardiographic differences were present despite similar values of NT-proBNP in both groups.Conclusion: HIV-exposed uninfected children may be vulnerable to ventricular systolic dysfunction at long term. Cardiovascular surveillance and periodic monitoring of biventricular function are therefore recommended. Myocardial peak systolic velocity may be a useful screening tool for this purpose.What is Known:• Previous studies on HIV-exposed uninfected children subjected prenatally to antiretroviral therapy have alerted to potential long-term cardiovascular toxicity effects on the left ventricle.What is New:• The study gives new insights on ventricular function and morphology in HIV-exposed uninfected children.• Myocardial peak systolic velocities are significantly inferior in this paediatric sub-group, therefore long-term cardiac surveillance is recommended.
HIV 阴性的儿童在子宫内接触病毒并接受预防性抗逆转录病毒治疗，其长期心肌功能障碍的风险不确定。本研究旨在分析他们的心室结构和功能，并为这一高危人群确定潜在的筛查工具。纳入了 115 名年龄在 2.7 至 16.2 岁之间的儿童（77 名暴露组和 38 名对照组）。进行了超声心动图研究，评估了两个心室的大小和收缩功能。在左心室中，还分析了与舒张功能相关的参数。在基础状态和被动抬腿后测定组织多普勒值。进行氨基末端脑钠肽前体（NT-proBNP）的血清学分析。两组的心室大小和左心室舒张功能相同。然而，暴露组的心肌收缩峰值速度评估的收缩性明显较差。尽管两组的 NT-proBNP 值相似，但仍存在这些收缩性超声心动图差异。结论：HIV 暴露的未感染儿童可能长期存在心室收缩功能障碍的风险。因此，建议进行心血管监测和定期监测双心室功能。心肌收缩峰值速度可能是一种有用的筛查工具。已知：• 以前对接受过产前抗逆转录病毒治疗的 HIV 未感染儿童进行的研究引起了对左心室潜在长期心血管毒性作用的关注。新内容：• 该研究提供了 HIV 未感染儿童心室功能和形态的新见解。• 该儿科亚组的心肌收缩峰值速度明显较低，因此建议进行长期心脏监测。
