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Myocardial peak systolic velocity—a tool for cardiac screening of HIV-exposed uninfected children

  • Original Article
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European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

HIV-uninfected children exposed prenatally to the virus and to prophylactic antiretroviral therapy are at an uncertain risk of long-term myocardial dysfunction. This study aimed to analyse the structure and function of their ventricles and to identify potential screening tools for this at-risk population. One hundred and fifteen children (77 exposed vs 38 controls) aged between 2.7 and 16.2 years were included. An echocardiographic study was performed where both ventricles’ dimensions and systolic functions were evaluated. In the left ventricle, parameters related to diastolic function were also analysed. Tissue Doppler values were determined in the basal state and after passive leg raising. Serologic analysis of amino-terminal pro-B-type natriuretic peptide (NT-proBNP) was carried out. The two groups had identical ventricular sizes and left ventricular diastolic functions. However, contractility assessed by myocardial peak systolic velocity was significantly inferior in the exposed group. These systolic echocardiographic differences were present despite similar values of NT-proBNP in both groups.

Conclusion: HIV-exposed uninfected children may be vulnerable to ventricular systolic dysfunction at long term. Cardiovascular surveillance and periodic monitoring of biventricular function are therefore recommended. Myocardial peak systolic velocity may be a useful screening tool for this purpose.

What is Known:

• Previous studies on HIV-exposed uninfected children subjected prenatally to antiretroviral therapy have alerted to potential long-term cardiovascular toxicity effects on the left ventricle.

What is New:

• The study gives new insights on ventricular function and morphology in HIV-exposed uninfected children.

• Myocardial peak systolic velocities are significantly inferior in this paediatric sub-group, therefore long-term cardiac surveillance is recommended.

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Abbreviations

BMI:

Body mass index

BP:

Blood pressure

E :

Early diastolic transmitral flow velocity

E′:

Early diastolic mitral annular velocity

E′2:

E′ evaluation after 90 s of passive leg raising

EF:

Ejection fraction

HEU:

HIV-exposed uninfected

HIV:

Human immunodeficiency virus

IUGR:

Intrauterine growth restriction

IVS:

Interventricular septal thickness in diastole

LV:

Left ventricle

LVAd_4C:

Left ventricle end-diastolic area in the 4-chamber view

LVAs_4C:

Left ventricle end-systolic area in the 4-chamber view

LVDD:

Left ventricle diastolic diameter

LVSD:

Left ventricle systolic diameter

Pw:

Posterior wall thickness in diastole

RV:

Right ventricle

RVAd_4C:

Right ventricle end-diastolic area in 4-chamber view

RVAs_4C:

Right ventricle end-systolic area in 4-chamber view

S′:

Myocardial peak systolic velocity

S′2:

S′ evaluation after 90 s of passive leg raising

SAVA’s:

Substance abuse, violence and acquired immunodeficiency syndrome

SF:

Shortening fraction

TAPSE :

Tricuspid annular plane systolic excursion

TDI:

Tissue Doppler imaging

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Funding

The work of JL Santos was partially supported by the Centre for Mathematics of the University of Coimbra—UID/MAT/00324/2013, funded by the Portuguese Government through FCT/MCTES and co-funded by the European Regional Development Fund through the Partnership Agreement PT2020.

Author information

Authors and Affiliations

  1. Paediatric Cardiology Service, Paediatric Hospital, Coimbra Hospital and Universitary Centre, Avenida Afonso Romão, 3000-602, Coimbra, Portugal

    Paula Martins, António Pires & M. Emanuel Albuquerque

  2. Coimbra Institute for Clinical and Biomedical Researh (iCBR) - Faculty of Medicine, University of Coimbra, Coimbra, Portugal

    Paula Martins, António Pires, Cristina Sena & Raquel Seiça

  3. Institute of Physiology - Faculty of Medicine, University of Coimbra, Coimbra, Portugal

    António Pires, Cristina Sena & Raquel Seiça

  4. Cardiology Service, Coimbra Hospital and Universitary Centre, Coimbra, Portugal

    Manuel Oliveira-Santos

  5. CMUC, Department of Mathematics, Faculty of Sciences and Technology, University of Coimbra, Coimbra, Portugal

    José Santos

Authors
  1. Paula Martins
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  2. António Pires
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  3. M. Emanuel Albuquerque
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  4. Manuel Oliveira-Santos
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  5. José Santos
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  6. Cristina Sena
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  7. Raquel Seiça
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Contributions

PM: participation in the design of the study, patient management, clinical evaluation, data collection, echocardiographic images acquisition and manuscript drafting.

AP: evaluation of the echocardiographic images, internal review of the manuscript.

MEA: patient management and clinical evaluation.

MS: evaluation of the echocardiographic images, internal review of the manuscript.

JS: statistical data analysis.

CS: participation in the design of the study, internal review of the manuscript, contributing to its final version.

RS: participation in the design of the study, internal review of the manuscript, contributing to its final version.

Corresponding author

Correspondence to Paula Martins.

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Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This article does not contain any studies using animals performed by any of the authors.

All procedures performed involving human participants were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from parents/legal tutors of all children who were included in the study.

Additional information

Communicated by Peter de Winter

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Martins, P., Pires, A., Albuquerque, M.E. et al. Myocardial peak systolic velocity—a tool for cardiac screening of HIV-exposed uninfected children. Eur J Pediatr 179, 395–404 (2020). https://doi.org/10.1007/s00431-019-03477-7

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  • DOI: https://doi.org/10.1007/s00431-019-03477-7

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