Yan Chengxi, Li Ruili, Guo Xiaojuan, Yu Huan, Li Wenhuan, Li Wenqiao, Ren Meiji, Yang Minglei, Li Hongjun
Department of Radiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China.
Front Cardiovasc Med. 2021 Nov 15;8:756162. doi: 10.3389/fcvm.2021.756162. eCollection 2021.
To investigate the subclinical imaging changes in terms of myocardial inflammation and fibrosis and to explore the risk factors associated with myocardial fibrosis by cardiac magnetic resonance (CMR) approach in a Chinese HIV/AIDS cohort. We evaluated myocardial function (cine), myocardial inflammation (T1, T2), and myocardial fibrosis (through extracellular volume fraction [ECV] and late gadolinium enhancement [LGE]) by a multiparametric CMR scan protocol in a total of 68 participants, including 47 HIV-infected individuals, who were divided into two groups: asymptomatic HIV (HIV+) (n = 30), and acquired immunodeficiency syndrome (AIDS) ( = 17), and 21 healthy controls. HIV-infected patients had lower left (55.3 ± 6.5 vs. 63.0 ± 7.9%, < 0.001) and right ventricular systolic function (35.9 ± 15.7 vs. 50.8 ± 9.3%, < 0.001). Radial systolic strain (30.7 ± 9.3 vs. 39.3 ± 9.4%, = 0.001), circumferential systolic strain (-17.5 ± 2.6 vs. -19.4 ± 2.7%, = 0.008), and longitudinal systolic strain (-9.4 ± 5.7 vs. -12.8 ± 3.1%, = 0.012) were also decreased in HIV. Native T1 relaxation time (1,337.2 ± 70.2 vs. 1,249.5 ± 47.0 ms, < 0.001), ECV value (33.5 ± 6.2 vs. 28.5 ± 2.9 ms, = 0.026), and T2 relaxation time (45.2 ± 3.5 vs. 42.0 ± 2.6 ms, = 0.001) were higher in HIV-infected patients compared with controls. Myocardial fibrosis, predominantly in the mid-inferior wall, was detected in 24.4% of the HIV-infected patients. HIV+ had a significantly lower value of ECV [29.1 (26.1, 31.8) vs. 35.2 (31.8, 41.9) %, < 0.001] and frequency of LGE [3/25 (8%) vs. 7/16 (43.8%), = 0.014)] compared with AIDS. AIDS was associated with myocardial fibrosis. HIV-infected patients were associated with changes in myocardial function and higher rates of subclinical myocardial inflammation and fibrosis, which were more abnormal with greater severity of the disease. AIDS was associated with myocardial fibrosis, where the observations supported earlier initiation of antiretroviral therapy in the Chinese HIV/AIDS cohort.
采用心脏磁共振成像（CMR）方法，在中国HIV/AIDS队列中研究心肌炎症和纤维化的亚临床影像学变化，并探索与心肌纤维化相关的危险因素。我们通过多参数CMR扫描方案对68名参与者进行了评估，包括心肌功能（电影成像）、心肌炎症（T1、T2）和心肌纤维化（通过细胞外容积分数[ECV]和钆延迟增强[LGE]），其中包括47名HIV感染者，他们被分为两组：无症状HIV感染者（HIV+）（n = 30）和获得性免疫缺陷综合征（AIDS）患者（n = 17），以及21名健康对照者。HIV感染患者的左心室（55.3±6.5%对63.0±7.9%，P<0.001）和右心室收缩功能较低（35.9±15.7%对50.8±9.3%，P<0.001）。HIV感染者的径向收缩应变（30.7±9.3%对39.3±9.4%，P = 0.001）、圆周收缩应变（-17.5±2.6%对-19.4±2.7%，P = 0.008）和纵向收缩应变（-9.4±5.7%对-12.8±3.1%，P = 0.012）也降低。与对照组相比，HIV感染患者的固有T1弛豫时间（1337.2±70.2毫秒对1249.5±47.0毫秒，P<0.001）、ECV值（33.5±6.2对28.5±2.9，P = 0.026）和T2弛豫时间（45.2±3.5对42.0±2.6毫秒，P = 0.001）更高。在24.4%的HIV感染患者中检测到心肌纤维化，主要位于下后壁中部。与AIDS患者相比，HIV+患者的ECV值[29.1（26.1，31.8）%对35.2（31.8，41.9）%，P<0.001]和LGE频率[3/25（8%）对7/16（43.8%），P = 0.014]显著更低。AIDS与心肌纤维化相关。HIV感染患者与心肌功能改变以及更高的亚临床心肌炎症和纤维化发生率相关，疾病严重程度越高，异常越明显。AIDS与心肌纤维化相关，这些观察结果支持在中国HIV/AIDS队列中更早开始抗逆转录病毒治疗。
