Abstract 10808: Left Ventricular Diastolic Dysfunction in HIV-Negative Infants Exposed In Utero to Antiretroviral Therapy from HIV-Positive Mothers: The Prospective NHLBI CHAART-I Study
Background: HIV-negative children exposed in utero to antiretroviral therapy (ART) have decreased left ventricular (LV) mass, dimension, and septal wall thickness with increased contractility. Diastolic function has not been characterized in this population.
Hypothesis: Fetal exposure to ART will have adverse effects on LV diastolic function in HIV- exposed but uninfected children.
Methods: Serial echocardiograms were obtained at specific times from birth to 48 months from 148 HIV-negative children born to HIV-positive mothers, who were perinatally exposed to ART. The following 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'). Diastolic measurements in these children were compared with 130 normal controls.
Results: All the above indices were statistically significantly different in ART exposed children compared to controls. Both E and A were lower at all ages by 6.95 cm/sec (p=.001) and 11.98 cm/sec (p<.0001), respectively. E/A ratio was higher by 0.21, 0.45, and 0.28 units at 1 month, 12 months and 24 months of age respectively (all p's < 0.01), indicative of impaired compliance. LVE' and sep E' were lower at all ages by 0.84 cm/sec (p=.01) and 0.47cm/sec (p=.02) respectively, indicative of impaired relaxation. All children were asymptomatic.
Conclusions: Children who were exposed to ART in utero have subclinical yet statistically 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.
- © 2011 by American Heart Association, Inc.