The Use of Two-Dimensional Strain Measured by Speckle Tracking in the Identification of Incipient Ventricular Dysfunction in HIV-Infected Patients on Antiretroviral Therapy, Untreated HIV Patients and Healthy Controls

• Published in: Arquivos brasileiros de cardiologia Vol. 113; no. 4; pp. 737 - 745
• Main Authors: Rodrigues, Ronaldo Campos, Azevedo, Katia Martins Lopes de, Moscavitch, Samuel Datum, Setubal, Sergio, Mesquita, Claudio Tinoco
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira de Cardiologia - SBC 01-10-2019; Sociedade Brasileira de Cardiologia (SBC)
• Subjects: Adult; Aged; Aged, 80 and over; Antiretroviral Therapy, Highly Active - methods; CARDIAC & CARDIOVASCULAR SYSTEMS; Case-Control Studies; Cross-Sectional Studies; Diagnóstico por Imagem; Disfunção Ventricular Esquerda; Echocardiography - methods; Ecocardiografia Doppler; Female; HIV; HIV Infections - drug therapy; HIV Infections - physiopathology; Humans; Male; Middle Aged; Original; Pregnancy; Reference Values; Reproducibility of Results; Speckle Tracking; Statistics, Nonparametric; Strain; Stroke Volume - physiology; Síndrome de Imunodeficiência Adquirida; Terapia de Antirretroviral de Alta Atividade; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - physiopathology; Ventricular Disfunction,Left; Ecocardiografia Doppler; Speckle Tracking; Antiretroviral Therapy; Diagnóstico por Imagem; Highly Active; Strain; Terapia de Antirretroviral de Alta Atividade; HIV; Acquired Immunodeficiency Syndrome; Echocardiography, Doppler; Disfunção Ventricular Esquerda; Síndrome de Imunodeficiência Adquirida
• ISSN: 0066-782X; 1678-4170; 1678-4170
• DOI: 10.5935/abc.20190169

Most cardiovascular abnormalities in patients infected with the human immunodeficiency virus (HIV) have been associated with myocardial damage directly caused by the virus. Some cases, however, may be associated with adverse effects from antiretroviral therapy (ART). New ventricular function assessment techniques are capable of detecting early changes in the cardiac function of HIV-infected patients using or not using ART. The usefulness of these techniques has been little employed in these patients.
To investigate the potential influence of antiretroviral therapy (ART) on the occurrence of subclinical left ventricular systolic dysfunction evaluated by myocardial strain rate analysis using two-dimensional speckle tracking echocardiography (2-D Echo) in treated HIV patients compared to untreated patients and healthy individuals.
Sixty-eight HIV-infected patients with no cardiovascular symptoms, normal left ventricular (LV) ejection fraction (> 0.55 on 2-D Echo) were divided into three groups: 11 patients not using antiretroviral therapy (NT), 24 using protease inhibitor (PI) and 33 using non-nucleoside reverse transcriptase inhibitor (NNRTI). We also studied 30 normal non-HIV infected individuals (Ctrl). Demographic, clinical, biochemical and anthropometric data were collected. Preliminary transthoracic echocardiography included study of myocardial strain using two-dimensional speckle tracking. We studied strain and strain rate in the seventeen left ventricular (LV) myocardial segments in the longitudinal, circumferential and radial axes. Statistical analysis of the data was done with IBM SPSS - version 20 for Windows. Upon analysis of the data, namely the normality of independent variables in the different groups and the homogeneity of the variances between the groups, Kruskal-Wallis' non-parametric test was done, followed by Dunn's multiple comparison tests to test the significance of the differences between the values measured in the study groups. A significance level of 5% was adopted for decision-making on statistical tests.
The mean age of HIV patients was 40 ± 8.65 years and the mean age of controls was 50 ± 11.6 years (p < 0.001). Median LV global longitudinal strain (GLS) of NT patients (-17.70%), PI patients (-18.27%) and NNRTIs (-18.47%) were significantly lower than that of the Ctrl group (-20.77%; p = 0.001). There was no significant difference in mean SLG between treated patients (PI, NNRTI) and untreated (NT) patients. No significant differences were observed in mean circumferential and radial strain, nor on circumferential and radial strain rates between the NT, PI, NNRTI and Ctrl groups.
The data suggest that HIV patients present, on myocardial strain measured by speckle tracking, signs of early LV systolic dysfunction that seem to be unrelated to the presence of ART. The prognostic significance of this condition in these patients deserves further studies.