Predictors of myocardial dysfunction in human immunodeficiency virus-infected patients.
BACKGROUND
Some of the most frequent manifestations of heart involvement in human immunodeficiency virus (HIV) infection include right and left ventricular dysfunction. The pathogenesis remains obscure.


RESULTS
This prospective clinical and echocardiographic study involved 181 patients at all stages of HIV infection. We tested a set of clinical variables using a backward logistic regression model to assess their ability to independently predict the presence of ventricular dysfunction. The presence of pulmonary infections (all etiologies mixed) was the only variable independently associated with isolated right ventricular dysfunction (odds ratio = 4.08; P = .02). Signs suggestive of pulmonary arterial hypertension were present in 71% of the patients with right ventricular dilation. History of previous opportunistic infections (all etiologies mixed) (odds ratio = 10.9; P = .0026) and time since the diagnosis of acquired immunodeficiency syndrome more than 12 months (odds ratio = 6.6; P = .03) were the only two independent predictors of left ventricular dysfunction.


CONCLUSIONS
Isolated right ventricular dysfunction may be secondary to pulmonary hypertension caused by repetitive pulmonary infections and not to primary myocardial disease. The aggressive treatment of opportunistic infections may become an important element of heart failure prophylaxis in HIV infection because they may be associated with left ventricular dysfunction.
Silva-Cardoso
J
J
Porto Cardiovascular Research, Porto Medical School, Hospital de S. João, Portugal.
Moura
B
B
Ferreira
A
A
Martins
L
L
Bravo-Faria
D
D
Mota-Miranda
A
A
Rocha-Gonçalves
F
F
Lecour
H
H
Cerqueira-Gomes
M
M
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications; D000328:Adult; D000704:Analysis of Variance; D004452:Echocardiography; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*