Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
University of Pittsburgh HIV-Comorbidities Research Training Programme in South Africa, Cape Town, South Africa.
ESC Heart Fail. 2024 Apr;11(2):748-758. doi: 10.1002/ehf2.14603. Epub 2023 Dec 15.
Biochemical markers are fundamental in cardiac evaluation, and various novel assays have recently been discovered. We prospectively evaluated the hearts of newly diagnosed people living with human immunodeficiency virus (PLWH) using cardiac biomarkers, compared them with human immunodeficiency virus (HIV)-uninfected controls, and correlated our prospective findings with cardiovascular magnetic resonance imaging (CMR).
Newly diagnosed, antiretroviral therapy (ART)-naïve PLWH were recruited along with HIV-uninfected, age-matched, and sex-matched controls. All participants underwent measurement of high-sensitivity cardiac troponin T (hs-cTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), soluble ST2 (sST2), and galectin-3, as well as a CMR study with multiparametric mapping. The HIV group started ART and was re-evaluated 9 months later. The cardiac biomarkers and their correlation with CMR parameters were evaluated in and between groups. Compared with controls (n = 22), hs-cTnT (4.0 vs. 5.1 ng/L; P = 0.004), NT-proBNP (23.2 vs. 40.8 ng/L; P = 0.02), and galectin-3 (6.8 vs. 9.0 ng/mL; P = 0.002) were all significantly higher in the ART-naïve group (n = 73). After 9 months of ART, hs-cTnT (5.1 vs. 4.3 ng/L; P = 0.02) and NT-proBNP (40.8 vs. 28.5 ng/L; P = 0.03) both decreased significantly and a trend of decrease was seen in sST2 (16.5 vs. 14.8 ng/L; P = 0.08). Galectin-3 did not demonstrate decrease over time (9.0 vs. 8.8 ng/mL; P = 0.6). The cardiac biomarkers that showed the best correlation with CMR measurements native T1, T2, and extracellular volume were NT-proBNP (r ≥ 0.4, P < 0.001) and galectin-3 (r ≥ 0.3, P < 0.01).
Our cardiac biomarker data support the presence of subclinical myocardial injury, remodelling, and fibrosis at HIV diagnosis, and ART had a positive influence on these blood markers. It remains unclear if the underlying pathological processes were fully addressed by ART. The ability of cardiac biomarkers to detect and track tissue abnormalities diagnosed with CMR showed promise. With additional research, this could lead to improvements in screening and monitoring myocardial abnormalities, even in CMR-limited settings.
生化标志物在心脏评估中至关重要，最近发现了各种新的检测方法。我们前瞻性地评估了新诊断的人类免疫缺陷病毒（PLWH）患者的心脏，使用心脏生物标志物将其与未感染 HIV 的对照进行比较，并将我们的前瞻性发现与心血管磁共振成像（CMR）相关联。
招募了新诊断的、未接受抗逆转录病毒治疗（ART）的 PLWH 以及未感染 HIV、年龄和性别匹配的对照组。所有参与者均接受高敏肌钙蛋白 T（hs-cTnT）、N 末端 pro-B 型利钠肽（NT-proBNP）、可溶性 ST2（sST2）和半乳糖凝集素-3 的测量，以及具有多参数映射的 CMR 研究。HIV 组开始接受 ART 治疗，并在 9 个月后重新评估。评估了各组内和组间的心脏生物标志物及其与 CMR 参数的相关性。与对照组（n=22）相比，hs-cTnT（4.0 与 5.1ng/L；P=0.004）、NT-proBNP（23.2 与 40.8ng/L；P=0.02）和半乳糖凝集素-3（6.8 与 9.0ng/mL；P=0.002）在未接受 ART 的组（n=73）中均显著升高。接受 9 个月的 ART 治疗后，hs-cTnT（5.1 与 4.3ng/L；P=0.02）和 NT-proBNP（40.8 与 28.5ng/L；P=0.03）均显著降低，sST2 呈降低趋势（16.5 与 14.8ng/L；P=0.08）。半乳糖凝集素-3在时间上没有显示出下降（9.0 与 8.8ng/mL；P=0.6）。与 CMR 测量值原生 T1、T2 和细胞外体积相关性最好的心脏生物标志物是 NT-proBNP（r≥0.4，P<0.001）和半乳糖凝集素-3（r≥0.3，P<0.01）。
我们的心脏生物标志物数据支持在 HIV 诊断时存在亚临床心肌损伤、重塑和纤维化，ART 对这些血液标志物有积极影响。尚不清楚 ART 是否完全解决了潜在的病理过程。心脏生物标志物检测和跟踪 CMR 诊断的组织异常的能力显示出了希望。随着进一步的研究，这可能会导致改善心肌异常的筛查和监测，即使在 CMR 受限的情况下也是如此。
