Lipshultz Steven E, Sasaki Nao, Thompson Bruce, Eidem Benjamin W, Cheng Irene, Colan Steven D, O'Brien Sharon E, Amdani Shahnawaz, Shearer William T, Orav Endel John, Miller Tracie L, Wilkinson James D
Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Oishei Children's Hospital, Roswell Park Comprehensive Cancer Center, Buffalo, New York.
Heart Program, Nicklaus Children's Hospital, Miami, Florida.
AIDS. 2020 Mar 15;34(4):529-537. doi: 10.1097/QAD.0000000000002443.
To longitudinally measure LV diastolic function in HIV-exposed but uninfected (HEU) children perinatally exposed to ART.
HEU children who were perinatally exposed to antiretroviral therapy (ART) may be at risk for adverse cardiac effects. We have previously reported that those children have decreased left ventricular (LV) mass, dimension, and septal thickness with increased contractility.
Serial echocardiograms were obtained at specific times from birth to 48 months from two groups of HIV-uninfected children: 148 HIV-negative children who were perinatally exposed to ART and 130 non-ART-exposed HIV-unexposed healthy controls. The following LV diastolic indices were obtained: mitral valve early and late diastolic velocity (E and A), tissue Doppler-derived LV-free wall and septal early diastolic velocity (LV e' and sep e').
All echocardiographic indices were significantly different in ART-exposed children compared with ART-unexposed healthy controls. Both E and A were overall lower at all ages by 8.28 cm/s (P = 0.0002) and 13.46 cm/s (P < 0.0001) respectively. E/A ratio was higher by 0.27, 0.46, and 0.28 units at birth, 1 year and 2 years of age, respectively (all P ≤ 0.01). Moreover, LV e' and sep e' were overall lower at all ages by 0.84 cm/s (P = 0.01) and 0.47 cm/s (P = 0.02), respectively.
Children who were exposed to ART in utero have subclinical yet significant differences in specific LV diastolic indices. Follow-up with serial echocardiograms are recommended in this population to further assess the potential cardiac toxicity of perinatal exposure to ART.
纵向测量围产期暴露于抗逆转录病毒治疗（ART）的HIV暴露未感染（HEU）儿童的左心室舒张功能。
围产期暴露于抗逆转录病毒疗法（ART）的HEU儿童可能存在心脏不良影响的风险。我们之前曾报道，这些儿童左心室（LV）质量、尺寸和室间隔厚度减小，收缩力增加。
从两组未感染HIV的儿童中，在特定时间（从出生到48个月）获取系列超声心动图：148名围产期暴露于ART的HIV阴性儿童和130名未暴露于ART的HIV未暴露健康对照。获取以下左心室舒张指标：二尖瓣舒张早期和晚期速度（E和A）、组织多普勒衍生的左心室游离壁和室间隔舒张早期速度（LV e'和sep e'）。
与未暴露于ART的健康对照相比，暴露于ART的儿童所有超声心动图指标均有显著差异。E和A在所有年龄段总体分别降低8.28 cm/s（P = 0.0002）和13.46 cm/s（P < 0.0001）。E/A比值在出生时、1岁和2岁时分别高出0.27、0.46和0.28个单位（所有P≤0.01）。此外，LV e'和sep e'在所有年龄段总体分别降低0.84 cm/s（P = 0.01）和0.47 cm/s（P = 0.02）。
子宫内暴露于ART的儿童在特定左心室舒张指标方面存在亚临床但显著的差异。建议对该人群进行系列超声心动图随访，以进一步评估围产期暴露于ART的潜在心脏毒性。
