title: Abnormal cardiac strain in children and young adults with HIV acquired in early life.
abstract: BACKGROUND
  Traditional measures of cardiac function are now often normal in adolescents and young adults treated with antiretroviral therapy for human immunodeficiency virus (HIV) infection. There is, however, evidence of myocardial abnormalities in adults with HIV. Cardiac strain analysis may detect impairment in cardiac function that may be missed by conventional measurements in this population.
  
  
  METHODS
  This was a retrospective study in which echocardiograms of HIV-infected subjects (n = 28) aged 7 to 29 years who participate in a natural history study of HIV acquired early in life were analyzed and compared with matched controls. Standard echocardiographic measures, along with speckle tracking-derived strain and strain rate, were assessed.
  
  
  RESULTS
  Among the HIV-infected subjects, the median CD4 count was 667 cells/mm(3), and the mean duration of antiretroviral therapy was 14.6 years. Ejection fractions and fractional shortening were normal. There were no significant differences in measures of systolic or diastolic function between the groups. The HIV-infected group had borderline increased left ventricular mass indices. Global longitudinal and circumferential strain and strain rate, as well as global radial strain rate, were significantly impaired in the HIV-infected group compared with controls. There were no associations identified between left ventricular mass index or strain indices and current CD4 count, CD4 nadir, HIV viral load, or duration of antiretroviral therapy.
  
  
  CONCLUSIONS
  HIV-infected participants demonstrated impaired strain and strain rate despite having normal systolic function and ejection fractions. Strain and strain rate may prove to be prognostic factors for long-term myocardial dysfunction. Therefore, asymptomatic children and young adults with long-standing HIV infection may benefit from these more sensitive measures.
authors.affiliation: Department of Cardiology, Children's National Medical Center, Washington, District of Columbia, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Sims
authors.forename: Lowell
authors.initials: L
authors.lastname: Frank
authors.forename: Russell
authors.initials: R
authors.lastname: Cross
authors.forename: Sarah
authors.initials: S
authors.lastname: Clauss
authors.forename: David
authors.initials: D
authors.lastname: Dimock
authors.forename: Julia
authors.initials: J
authors.lastname: Purdy
authors.forename: Irene
authors.initials: I
authors.lastname: Mikhail
authors.forename: Rohan
authors.initials: R
authors.lastname: Hazra
authors.forename: Colleen
authors.initials: C
authors.lastname: Hadigan
authors.forename: Craig
authors.initials: C
authors.lastname: Sable
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004452:Echocardiography / Q000379:methods*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*; D055815:Young Adult