Malawi 成年人艾滋病毒感染者心脏超声筛查左心室肥厚发生率较高。

High rate of left ventricular hypertrophy on screening echocardiography among adults living with HIV in Malawi.

机构信息

Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at the University of California, Los Angeles, California, USA

Partners in Hope, Lilongwe, Malawi.

出版信息

Open Heart. 2022 May;9(1). doi: 10.1136/openhrt-2022-002026.

DOI:10.1136/openhrt-2022-002026

PMID:35649574

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9161066/

Abstract

BACKGROUND

There are limited data on structural heart disease among people living with HIV in southern Africa, where the success of antiretroviral therapy (ART) has drastically improved life expectancy and where risk factors for cardiovascular disease are prevalent.

METHODS

We performed a cross-sectional study of screening echocardiography among adults (≥18 years) with HIV in Malawi presenting for routine ART care. We used univariable and multivariable logistic regression to evaluate correlates of abnormal echocardiogram.

RESULTS

A total of 202 individuals were enrolled with a median age of 45 years (IQR 39-52); 52% were female, and 27.7% were on antihypertensive medication. The most common clinically significant abnormality was left ventricular hypertrophy (LVH) (12.9%, n=26), and other serious structural heart lesions were rare (<2% with ejection fraction less than 40%, moderate-severe valve lesions or moderate-severe pericardial effusion). Characteristics associated with abnormal echocardiogram included older age (OR 1.04, 95% CI 1.01 to 1.08), higher body mass index (OR 1.09, 95% CI 1.02 to 1.17), higher mean systolic blood pressure (OR 1.03, 95% CI 1.02 to 1.05) and higher mean diastolic blood pressure (OR 1.03, 95% CI 1.01 to 1.05). In a multivariable model including age, duration on ART, body mass index, and systolic and diastolic blood pressure, only mean body mass index (adjusted OR 1.10, 95% CI 1.02 to 1.19), systolic blood pressure (aOR 1.05, 95% CI 1.03 to 1.08) and diastolic blood pressure (aOR 0.96, 95% CI 0.92 to 1.00) remained associated with abnormal echocardiogram.

CONCLUSIONS

LVH was common in this population of adults on ART presenting for routine care and was associated with elevated blood pressure. Further research is needed to characterise the relationship between chronic hypertension, LVH and downstream consequences, such as diastolic dysfunction and heart failure in people living with HIV.

摘要

背景

在南部非洲，艾滋病毒感染者的结构性心脏病数据有限，抗逆转录病毒疗法 (ART) 的成功大大提高了预期寿命，心血管疾病的风险因素也普遍存在。

方法

我们对马拉维接受常规 ART 护理的成年人（≥18 岁）进行了超声心动图筛查的横断面研究。我们使用单变量和多变量逻辑回归来评估异常超声心动图的相关因素。

结果

共纳入 202 名参与者，中位年龄为 45 岁（IQR 39-52）；52%为女性，27.7%正在服用降压药。最常见的临床显著异常是左心室肥厚（LVH）（12.9%，n=26），其他严重的结构性心脏病变很少见（<2%射血分数<40%、中度至重度瓣膜病变或中度至重度心包积液）。与异常超声心动图相关的特征包括年龄较大（OR 1.04，95%CI 1.01-1.08）、体重指数较高（OR 1.09，95%CI 1.02-1.17）、平均收缩压较高（OR 1.03，95%CI 1.02-1.05）和平均舒张压较高（OR 1.03，95%CI 1.01-1.05）。在一个包含年龄、ART 持续时间、体重指数以及收缩压和舒张压的多变量模型中，只有平均体重指数（调整后的 OR 1.10，95%CI 1.02-1.19）、收缩压（aOR 1.05，95%CI 1.03-1.08）和舒张压（aOR 0.96，95%CI 0.92-1.00）与异常超声心动图相关。