Abnormal Myocardial Function Is Related to Myocardial Steatosis and Diffuse Myocardial Fibrosis in HIV-Infected Adults

作者：Thiara Diana K; Liu Chia Ying; Raman Fabio; Mangat Sabrina; Purdy Julia B; Duarte Horacio A; Schmidt Nancyanne; Hur Jamie; Sibley Christopher T; Bluemke David A; Hadigan Colleen^*

来源：Journal of Infectious Diseases, 2015, 212(10): 1544-1551.

DOI：10.1093/infdis/jiv274

• HIV
• intramyocardial lipid
• myocardial strain
• magnetic resonance spectroscopy
• antiretroviral therapy

Background. Impaired cardiac function persists in the era of effective human immunodeficiency virus (HIV) therapy, although the etiology is unclear. We used magnetic resonance imaging (MRI) to measure intramyocardial lipid levels and fibrosis as possible contributors to HIV-associated myocardial dysfunction.
Methods. A cross-sectional study of 95 HIV-infected and 30 matched-healthy adults, without known cardiovascular disease (CVD) was completed. Intramyocardial lipid levels, myocardial fibrosis, and cardiac measured on the basis of strain) were quantified by MRI.
Results. Systolic function was significantly decreased in HIV-infected subjects as compared to controls (mean radial strain [+/- SD], 21.7 +/- 8.6% vs 30.5 +/- 14.2%; P = .004). Intramyocardial lipid level and fibrosis index were both increased in HIV-infected subjects as compared to controls (P <=.04 for both) and correlated with the degree of myocardial dysfunction measured by strain parameters. Intramyocardial lipid levels correlated positively with antiretroviral therapy duration and visceral adiposity. Further, impaired myocardial function was strongly correlated with increased monocyte chemoattractant protein 1 levels (r = 0.396, P = .0002) and lipopolysaccharide binding protein levels (r = 0.25, P = .02).
Conclusions. HIV-infected adults have reduced myocardial function as compared to controls in the absence of known CVD. Decreased cardiac function was associated with abnormal myocardial tissue composition characterized by increased lipid levels and diffuse myocardial fibrosis. Metabolic alterations related to antiretroviral therapy and chronic inflammation may be important targets for optimizing long-term cardiovascular health in HIV-infected individuals.

• 出版日期2015-11-15