Skip to main content

Advertisement

SpringerLink
Log in

HIV Patients Have Impaired Diastolic Function that is Not Aggravated by Anti-Retroviral Treatment

  • ORIGINAL ARTICLE
  • Published:
Cardiovascular Drugs and Therapy Aims and scope Submit manuscript

Abstract

Purpose

Recent studies have shown that HIV infection is independently associated with heart failure. Diastolic dysfunction (DD) is frequent in HIV patients, but it is unclear whether this is an effect of the HIV infection itself or of the anti-retroviral therapy (ART). Our aim was to compare diastolic function in HIV treatment-naïve, HIV-ART patients and controls.

Methods

We prospectively enrolled 206 consecutive patients with HIV-1 infection and 30 controls, selected by frequency matching for age and sex. HIV patients were divided in two subgroups: ART-naïve (n = 88) and ART (n = 118). Diastolic function was assessed and graded by echocardiography, according to modern consensus criteria and using tissue Doppler analysis.

Results

Compared to controls, ART-naïve patients had lower E’ velocities (E’ septal: 10.2 ± 2.4 vs 11.9 ± 2.6 cm/s, p = 0.02), higher E/E’ ratio (7.8 ± 1.9 vs 6.9 ± 1.6,p = 0.02) and higher prevalence of DD (19 % vs 3.3 %,p = 0.05). HIV patients under ART also had worse diastolic function compared to controls (E’ septal: 10.3 ± 2.5 cm/s;p < 0.01; E/E’ratio: 8.0 ± 2.0,p < 0.01; DD prevalence: 23 %;p = 0.01), but no significant differences were found between ART-naïve and ART HIV subgroups. In multivariable logistic regression analysis, age and body mass index were the only independent predictors of reduced diastolic reserve in HIV patients. Regarding systolic function, there were no significant differences in ejection fraction or S’ velocities between controls and HIV subgroups.

Conclusions

HIV treatment-naïve patients have reduced diastolic reserve that is not worsened by ART. These data reinforce the association of diastolic dysfunction with the HIV infection itself and not with the anti-retroviral therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Triant VA, Lee H, Hadigan C, Grinspoon SK. Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease. J Clin Endocrinol Metab. 2007;92:2506–12.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Durand M, Sheehy O, Baril JG, Lelorier J, Tremblay CL. Association between HIV infection, antiretroviral therapy, and risk of acute myocardial infarction: a cohort and nested case–control study using Quebec’s public health insurance database. J Acquir Immune Defic Syndr. 2011;57:245–53.

    Article  PubMed  Google Scholar 

  3. Islam FM, Wu J, Jansson J, Wilson DP. Relative risk of cardiovascular disease among people living with HIV: a systematic review and meta-analysis. HIV Med. 2012;13:453–68.

    CAS  PubMed  Google Scholar 

  4. Data Collection on Adverse Events of Anti HIVdSG, Smith C, Sabin CA, Lundgren JD, Thiebaut R, Weber R, et al. Factors associated with specific causes of death amongst HIV-positive individuals in the D:A:D Study. AIDS. 2010;24:1537–48.

    Google Scholar 

  5. Hemkens LG, Bucher HC. HIV infection and cardiovascular disease. Eur Heart J. 2014;35:1373–81

  6. Bucher HC, Richter W, Glass TR, Magenta L, Wang Q, Cavassini M, et al. Small dense lipoproteins, apolipoprotein B, and risk of coronary events in HIV-infected patients on antiretroviral therapy: the Swiss HIV Cohort Study. J Acquir Immune Defic Syndr. 2012;60:135–42.

    Article  CAS  PubMed  Google Scholar 

  7. Worm SW, Kamara DA, Reiss P, Kirk O, El-Sadr W, Fux C, et al. Elevated triglycerides and risk of myocardial infarction in HIV-positive persons. AIDS. 2011;25:1497–504.

    Article  CAS  PubMed  Google Scholar 

  8. Lorenz MW, Stephan C, Harmjanz A, Staszewski S, Buehler A, Bickel M, et al. Both long-term HIV infection and highly active antiretroviral therapy are independent risk factors for early carotid atherosclerosis. Atherosclerosis. 2008;196:720–6.

    Article  CAS  PubMed  Google Scholar 

  9. Friis-Moller N, Sabin CA, Weber R, d’Arminio Monforte A, El-Sadr WM, Reiss P, et al. Combination antiretroviral therapy and the risk of myocardial infarction. N Engl J Med. 2003;349:1993–2003.

    Article  PubMed  Google Scholar 

  10. Butt AA, Chang CC, Kuller L, Goetz MB, Leaf D, Rimland D, et al. Risk of heart failure with human immunodeficiency virus in the absence of prior diagnosis of coronary heart disease. Arch Intern Med. 2011;171:737–43.

    PubMed Central  PubMed  Google Scholar 

  11. Hsue PY, Hunt PW, Ho JE, Farah HH, Schnell A, Hoh R, et al. Impact of HIV infection on diastolic function and left ventricular mass. Circ Heart Fail. 2010;3:132–9.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Mondy KE, Gottdiener J, Overton ET, Henry K, Bush T, Conley L, et al. High prevalence of echocardiographic abnormalities among HIV-infected persons in the era of highly active antiretroviral therapy. Clin Infect Dis. 2011;52:378–86.

    Article  PubMed  Google Scholar 

  13. Leite-Moreira AF. Current perspectives in diastolic dysfunction and diastolic heart failure. Heart. 2006;92:712–8.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Paulus WJ, Tschope C, Sanderson JE, Rusconi C, Flachskampf FA, Rademakers FE, et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J. 2007;28:2539–50.

    Article  PubMed  Google Scholar 

  15. Redfield MM, Jacobsen SJ, Burnett Jr JC, Mahoney DW, Bailey KR, Rodeheffer RJ. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA. 2003;289:194–202.

    Article  PubMed  Google Scholar 

  16. Aurigemma GP, Gottdiener JS, Shemanski L, Gardin J, Kitzman D. Predictive value of systolic and diastolic function for incident congestive heart failure in the elderly: the cardiovascular health study. J Am Coll Cardiol. 2001;37:1042–8.

    Article  CAS  PubMed  Google Scholar 

  17. Bella JN, Palmieri V, Roman MJ, Liu JE, Welty TK, Lee ET, et al. Mitral ratio of peak early to late diastolic filling velocity as a predictor of mortality in middle-aged and elderly adults: the Strong Heart Study. Circulation. 2002;105:1928–33.

    Article  PubMed  Google Scholar 

  18. Group DADS, Sabin CA, Worm SW, Weber R, Reiss P, El-Sadr W, et al. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: a multi-cohort collaboration. Lancet. 2008;371:1417–26.

    Article  Google Scholar 

  19. Paulus WJ, Tschope C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol. 2013;62(4):263–71.

    Article  PubMed  Google Scholar 

  20. Reinsch N, Neuhaus K, Esser S, Potthoff A, Hower M, Brockmeyer NH, et al. Prevalence of cardiac diastolic dysfunction in HIV-infected patients: results of the HIV-HEART study. HIV Clin Trials. 2010;11:156–62.

    Article  PubMed  Google Scholar 

  21. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification. Eur J Echocardiogr. 2006;7:79–108.

    Article  PubMed  Google Scholar 

  22. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr. 2009;10:165–93.

    Article  PubMed  Google Scholar 

  23. Holloway CJ, Ntusi N, Suttie J, Mahmod M, Wainwright E, Clutton G, et al. Comprehensive cardiac magnetic resonance imaging and spectroscopy reveal a high burden of myocardial disease in HIV patients. Circulation. 2013;128:814–22.

    Article  PubMed  Google Scholar 

  24. Meng Q, Lima JA, Lai H, Vlahov D, Celentano DD, Strathdee S, et al. Use of HIV protease inhibitors is associated with left ventricular morphologic changes and diastolic dysfunction. J Acquir Immune Defic Syndr. 2002;30:306–10.

    Article  CAS  PubMed  Google Scholar 

  25. Nayak G, Ferguson M, Tribble DR, Porter CK, Rapena R, Marchicelli M, et al. Cardiac diastolic dysfunction is prevalent in HIV-infected patients. AIDS Patient Care STDS. 2009;23:231–8.

    Article  PubMed  Google Scholar 

  26. Currie PF, Boon NA. Immunopathogenesis of HIV-related heart muscle disease: current perspectives. AIDS. 2003;17 Suppl 1:S21–8.

    Article  PubMed  Google Scholar 

  27. Tanuma J, Ishizaki A, Gatanaga H, Kikuchi Y, Kimura S, Hiroe M, et al. Dilated cardiomyopathy in an adult human immunodeficiency virus type 1-positive patient treated with a zidovudine-containing antiretroviral regimen. Clin Infect Dis. 2003;37:e109–11.

    Article  PubMed  Google Scholar 

  28. Seaberg EC, Munoz A, Lu M, Detels R, Margolick JB, Riddler SA, et al. Association between highly active antiretroviral therapy and hypertension in a large cohort of men followed from 1984 to 2003. AIDS. 2005;19:953–60.

    Article  PubMed  Google Scholar 

  29. Crane HM, Van Rompaey SE, Kitahata MM. Antiretroviral medications associated with elevated blood pressure among patients receiving highly active antiretroviral therapy. AIDS. 2006;20:1019–26.

    Article  CAS  PubMed  Google Scholar 

  30. Luo L, Zeng Y, Li T, Lv W, Wang H, Guo F, et al. Prospective echocardiographic assessment of cardiac structure and function in chinese persons living with HIV. Clin Infect Dis. 2014;58:1459–66.

    Article  PubMed  Google Scholar 

  31. Oliviero U, Bonadies G, Bosso G, Foggia M, Apuzzi V, Cotugno M, et al. Impaired diastolic function in naive untreated human immunodeficiency virus infected patients. World J Cardiol. 2010;2:98–103.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Sciarretta S, Ferrucci A, Ciavarella GM, De Paolis P, Venturelli V, Tocci G, et al. Markers of inflammation and fibrosis are related to cardiovascular damage in hypertensive patients with metabolic syndrome. Am J Hypertens. 2007;20:784–91.

    Article  CAS  PubMed  Google Scholar 

  33. Williams ES, Shah SJ, Ali S, Na BY, Schiller NB, Whooley MA. C-reactive protein, diastolic dysfunction, and risk of heart failure in patients with coronary disease: Heart and Soul Study. Eur J Heart Fail. 2008;10:63–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  34. Michowitz Y, Arbel Y, Wexler D, Sheps D, Rogowski O, Shapira I, et al. Predictive value of high sensitivity CRP in patients with diastolic heart failure. Int J Cardiol. 2008;125:347–51.

    Article  PubMed  Google Scholar 

  35. Westermann D, Van Linthout S, Dhayat S, Dhayat N, Schmidt A, Noutsias M, et al. Tumor necrosis factor-alpha antagonism protects from myocardial inflammation and fibrosis in experimental diabetic cardiomyopathy. Basic Res Cardiol. 2007;102:500–7.

    Article  CAS  PubMed  Google Scholar 

  36. Herskowitz A, Wu TC, Willoughby SB, Vlahov D, Ansari AA, Beschorner WE, et al. Myocarditis and cardiotropic viral infection associated with severe left ventricular dysfunction in late-stage infection with human immunodeficiency virus. J Am Coll Cardiol. 1994;24:1025–32.

    Article  CAS  PubMed  Google Scholar 

  37. Barbaro G, Di Lorenzo G, Grisorio B, Barbarini G. Cardiac involvement in the acquired immunodeficiency syndrome: a multicenter clinical-pathological study. Gruppo Italiano per lo Studio Cardiologico dei pazienti affetti da AIDS Investigators. AIDS Res Hum Retrovir. 1998;14:1071–7.

    Article  CAS  PubMed  Google Scholar 

  38. Kristoffersen US, Lebech AM, Gerstoft J, Hesse B, Petersen CL, Gutte H, et al. Right and left cardiac function in HIV-infected patients investigated using radionuclide ventriculography and brain natriuretic peptide: a 5-year follow-up study. HIV Med. 2008;9:180–6.

    Article  CAS  PubMed  Google Scholar 

  39. Sims A, Frank L, Cross R, Clauss S, Dimock D, Purdy J, et al. Abnormal cardiac strain in children and young adults with HIV acquired in early life. J Am Soc Echocardiogr. 2012;25:741–8.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Mansoor A, Golub ET, Dehovitz J, Anastos K, Kaplan RC, Lazar JM. The association of HIV infection with left ventricular mass/hypertrophy. AIDS Res Hum Retrovir. 2009;25:475–81.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  41. Tsang TS, Barnes ME, Gersh BJ, Bailey KR, Seward JB. Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden. Am J Cardiol. 2002;90:1284–9.

    Article  PubMed  Google Scholar 

Download references

Funding Sources

This work was supported by an European-Commission Grant FP7-Health-2010: MEDIA-261409 and by two Portuguese-Foundation-for-Science-and-Technology Grants PEst-C/SAU/UI0051/2014 and EXCL/BIM-MEC/0055/2012 (partially funded by FEDER through COMPETE).

Disclosures

None to declare.

Author information

Author notes

    Authors and Affiliations

    1. Cardiology Department, Gaia Hospital Center, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal

      Ricardo Fontes-Carvalho, Jennifer Mancio, Acúrcio Marcos, Francisco Sampaio & Vasco Gama

    2. Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal

      Adelino Leite-Moreira

    3. Department of Infectious Diseases, Gaia Hospital Center, Gaia, Portugal

      Margarida Mota

    4. Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal

      Francisco Rocha Gonçalves

    5. Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine, University of Porto, Porto, Portugal

      Ana Azevedo

    6. Department of Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal

      Adelino Leite-Moreira

    Authors
    1. Ricardo Fontes-Carvalho
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Jennifer Mancio
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Acúrcio Marcos
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Francisco Sampaio
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Margarida Mota
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Francisco Rocha Gonçalves
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Vasco Gama
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Ana Azevedo
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. Adelino Leite-Moreira
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Ricardo Fontes-Carvalho.

    Additional information

    Ricardo Fontes-Carvalho and Jennifer Mancio contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Fontes-Carvalho, R., Mancio, J., Marcos, A. et al. HIV Patients Have Impaired Diastolic Function that is Not Aggravated by Anti-Retroviral Treatment. Cardiovasc Drugs Ther 29, 31–39 (2015). https://doi.org/10.1007/s10557-015-6573-x

    Download citation

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s10557-015-6573-x

    Keywords

    Search

    Navigation