基于心脏 MRI 的无症状人类免疫缺陷病毒感染者心肌损伤评估：与 CD4 计数最低点的相关性。
Cardiac MRI-Based Assessment of Myocardial Injury in Asymptomatic People Living With Human Immunodeficiency Virus: Correlation With nadir CD4 Count.
机构信息
Department of Radiology, The First Hospital of China Medical University, Shenyang, China.
NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China.
出版信息
J Magn Reson Imaging. 2023 Dec;58(6):1815-1823. doi: 10.1002/jmri.28699. Epub 2023 Mar 29.
BACKGROUND
There are known cardiac manifestations of HIV, but the findings in asymptomatic subjects are still not fully explored.
PURPOSE
To evaluate for the presence of subclinical myocardial injury in asymptomatic people living with human immunodeficiency virus (PLWH) by cardiac MRI and to explore the possible association between subclinical myocardial injury and HIV-related clinical characteristics.
STUDY TYPE
Cross-sectional.
POPULATION
A total of 80 asymptomatic PLWH (age: 53 years [47-56 years]; 90% male) and 50 age- and sex-matched healthy participants.
FIELD STRENGTH/SEQUENCE: A 3-T, cine sequence, T1, T2, and T2* mapping.
ASSESSMENT
Function analysis was derived from short axis, two-, three-, and four-chamber cine images by feature tracking. Regions of interest were manually selected in the midventricular septum T1, T2, and T2* mapping sequences. PLWH were evaluated for T1 increment (△T1 mapping = native T1 - cutoff values) and HIV-related clinical characteristics, particularly the nadir CD4 count. And PLWH were stratified into two groups according to the cutoff value of native T1: elevated native T1 and normal.
STATISTICAL TESTS
T test, Wilcoxon rank-sum test, Chi-square test, Spearman rank correlation, and logistic regression. P <0.05 indicated statistical significance.
RESULTS
Asymptomatic PLWH revealed significantly higher native myocardial T1 values (1241 ± 29 msec vs. 1189 ± 21 msec), T2 values (40.7 ± 1.5 msec vs. 37.9 ± 1.4 msec), and lower LVGRS (30.2% ± 6.2% vs. 35.8% ± 6.4%), LVGCS (-18.0% ± 2.5% vs. -19.5% ± 2.0%), and LVGLS (-16.0% ± 3.8% vs. -17.9% ± 2.6%) but showed no difference in T2* values (17.3 msec [16.3-19.1 msec] vs. 18.3 msec [16.5-19.3 msec], P = 0.201). A negative correlation between the native T1 increment in PLWH with subclinical myocardial injury and the nadir CD4 count (u = -0.316). Nadir CD4 count <500 cells/mm was associated with higher odds of elevated native T1 myocardial values (odds ratio, 6.12 [95% CI, 1.07-34.91]) in PLWH.
DATA CONCLUSION
Subclinical myocardial inflammation and dysfunction were present in asymptomatic PLWH, and a lower nadir CD4 count may be a risk factor for subclinical myocardial injury.
EVIDENCE LEVEL
TECHNICAL EFFICACY
Stage 2.
背景
HIV 存在已知的心脏表现，但无症状患者的发现仍未完全探索。
目的
通过心脏 MRI 评估无症状人类免疫缺陷病毒（PLWH）患者是否存在亚临床心肌损伤，并探讨亚临床心肌损伤与 HIV 相关临床特征之间的可能关联。
研究类型
横断面。
人群
共纳入 80 名无症状 PLWH（年龄：53 岁[47-56 岁]；90%为男性）和 50 名年龄和性别匹配的健康参与者。
磁场强度/序列：3T，电影序列，T1、T2 和 T2*映射。
评估
功能分析来自短轴、两腔、三腔和四腔电影图像的特征跟踪。在中隔的 T1、T2 和 T2*映射序列中手动选择感兴趣区。评估 PLWH 的 T1 增量（△T1 映射=原生 T1- 截断值）和 HIV 相关临床特征，特别是最低 CD4 计数。根据原生 T1 的截断值，将 PLWH 分为两组：原生 T1 升高和正常。
统计学检验
T 检验、Wilcoxon 秩和检验、卡方检验、Spearman 秩相关和逻辑回归。P<0.05 表示具有统计学意义。
结果
无症状 PLWH 的原生心肌 T1 值（1241±29msec 与 1189±21msec）、T2 值（40.7±1.5msec 与 37.9±1.4msec）较高，左心室整体应变率（LVGRS）（30.2%±6.2%与 35.8%±6.4%）、左心室整体缩短率（LVGCS）（-18.0%±2.5%与-19.5%±2.0%）和左心室整体纵向应变率（LVGLS）（-16.0%±3.8%与-17.9%±2.6%）较低，但 T2*值无差异（17.3msec[16.3-19.1msec]与 18.3msec[16.5-19.3msec]，P=0.201）。PLWH 的原生 T1 增量与亚临床心肌损伤和最低 CD4 计数呈负相关（u=-0.316）。最低 CD4 计数<500 个/mm 与 PLWH 中升高的原生 T1 心肌值的更高可能性相关（优势比，6.12[95%置信区间，1.07-34.91]）。
数据结论
无症状 PLWH 存在亚临床心肌炎症和功能障碍，最低 CD4 计数可能是亚临床心肌损伤的危险因素。
证据水平
技术功效
2 级。
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