Comprehensive Cardiac Magnetic Resonance Imaging and Spectroscopy Reveals a High Burden of Myocardial Disease in HIV Patients
Background—To characterise myocardial abnormalities in a contemporary group of human immunodeficiency virus (HIV)-infected individuals on combination antiretroviral therapy (cART). HIV infection continues to be endemic worldwide. Whilst treatments are successful, it remains controversial whether patients receiving optimal therapy have structural, functional or biochemical cardiac abnormalities which may underlie the increased cardiac morbidity and mortality.
Methods and Results—Volunteers with HIV on cART and age-matched controls, without a history of cardiovascular disease, underwent cardiac Magnetic Resonance Imaging (MRI) and Spectroscopy (MRS) for the determination of cardiac function, myocardial fibrosis and myocardial lipid content. A total of 129 participants were included in this analysis. Compared to age-matched controls (n = 39, 30.23%), HIV-infected subjects on cART (n = 90, 69.77%) had 47% higher median myocardial lipids and 74% higher median plasma triglycerides levels (both p < 0.001). Myocardial fibrosis, predominantly in the basal infero-lateral wall of the left ventricle, was observed in 76% of HIV-infected subjects compared to 13 % of controls (p < 0.001). Peak myocardial systolic and diastolic longitudinal strain were also lower in HIV-infected individuals compared to controls and remained statistically significant after adjusting for available confounders.
Conclusions—Comprehensive cardiac imaging revealed cardiac steatosis, alterations in cardiac function and a high prevalence of myocardial fibrosis in a contemporary group of asymptomatic HIV-infected subjects on cART. Cardiac steatosis and fibrosis may underlie cardiac dysfunction and increased cardiovascular morbidity and mortality in subjects with HIV.
- Received January 30, 2013.
- Revision received June 15, 2013.
- Accepted June 24, 2013.