title: Isolated right ventricular dysfunction in patients with human immunodeficiency virus.
abstract: BACKGROUND
  HIV-infected individuals are at increased risk for pulmonary hypertension and cardiomyopathy, portending a poor prognosis. Right ventricular (RV) dysfunction is associated with worse outcomes in these conditions, yet its prevalence is poorly defined in HIV. We sought to determine the prevalence of RV dysfunction in an outpatient HIV cohort.
  
  
  METHODS
  Echocardiograms were evaluated from 104 HIV-infected adults. Measurements included estimated pulmonary arterial systolic pressure (PASP) and several measures of RV function, including tricuspid annular plane systolic excursion (TAPSE), RV longitudinal myocardial strain (RVLMS), RV fractional area change (RVFAC), and myocardial performance index (MPI).
  
  
  RESULTS
  Sixteen subjects (15%) had PASP >35 mm Hg, yet RV function did not differ significantly from those with normal estimated PASP. RV dysfunction defined by RVFAC <35% occurred in 11%. RVLMS had a median value of -27.3%, and individuals below the median had lower TAPSE but no differences in left ventricular ejection fraction (LVEF), PASP, or other measures. Dyspnea was associated with the lowest quintile of RVLMS (≥-21.05%). There were 6 subjects with LVEF <50%, and these individuals had lower TAPSE but no differences in PASP or other RV functional measures.
  
  
  CONCLUSIONS
  RV dysfunction was common as estimated PASP >35 mm Hg and LV dysfunction, but these findings did not cosegregate. RV dysfunction in HIV-infected individuals may be a separate entity from LV/global cardiomyopathy or pulmonary hypertension and deserves further study.
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh.|Department of Bioengineering, University of Pittsburgh.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Simon
authors.affiliation: Dietrich School of Arts and Sciences; University of Pittsburgh.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Lacomis
authors.affiliation: Department of Medicine, University of Pittsburgh.
authors.forename: M Patricia
authors.initials: MP
authors.lastname: George
authors.affiliation: Department of Medicine, University of Pittsburgh.
authors.forename: Cathy
authors.initials: C
authors.lastname: Kessinger
authors.affiliation: Department of Medicine, University of Pittsburgh.
authors.forename: Renee
authors.initials: R
authors.lastname: Weinman
authors.affiliation: Department of Medicine, University of Pittsburgh.
authors.forename: Deborah
authors.initials: D
authors.lastname: McMahon
authors.affiliation: Department of Medicine, University of Pittsburgh.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Gladwin
authors.affiliation: Department of Medicine, University of Pittsburgh.
authors.forename: Hunter C
authors.initials: HC
authors.lastname: Champion
authors.affiliation: Department of Medicine, University of Pittsburgh.|Department of Immunology, School of Medicine; University of Pittsburgh.
authors.forename: Alison
authors.initials: A
authors.lastname: Morris
mesh_terms: D000328:Adult; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D014463:Ultrasonography; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000821:virology
keywords: HIV; Pulmonary hypertension; cardiomyopathy; right ventricle
references.citation: BMJ. 1994 Dec 17;309(6969):1605-7
references.pmid: 7819934
references.citation: Chest. 2010 Feb;137(2):376-87
references.pmid: 19837821
references.citation: J Am Coll Cardiol. 1998 Oct;32(4):948-54
references.pmid: 9768716
references.citation: J Am Coll Cardiol. 2001 Jan;37(1):183-8
references.pmid: 11153735
references.citation: Cardiol J. 2010;17(6):587-93
references.pmid: 21154261
references.citation: Chest. 2011 Jul;140(1):4-6
references.pmid: 21729886
references.citation: Circulation. 1984 Oct;70(4):657-62
references.pmid: 6478568
references.citation: Circulation. 1980 Aug;62(2):212-7
references.pmid: 7397962
references.citation: Am J Respir Crit Care Med. 2008 Jan 1;177(1):108-13
references.pmid: 17932378
references.citation: Cardiovasc Ultrasound. 2010 Jan 22;8:3
references.pmid: 20096122
references.citation: Chest. 2010 Jun;137(6 Suppl):6S-12S
references.pmid: 20522575
references.citation: Chest. 1991 Nov;100(5):1268-71
references.pmid: 1935280
references.citation: J Am Soc Echocardiogr. 2011 Oct;24(10):1101-8
references.pmid: 21775102
references.citation: Haematologica. 2006 Jun;91(6):744-9
references.pmid: 16769575
references.citation: Chest. 2004 Jul;126(1 Suppl):78S-92S
references.pmid: 15249497
references.citation: Am Heart J. 2004 Mar;147(3):482-8
references.pmid: 14999198
references.citation: Am J Respir Crit Care Med. 2010 Sep 15;182(6):790-6
references.pmid: 20522793
references.citation: J Am Coll Cardiol. 1985 Apr;5(4):918-27
references.pmid: 3973294
references.citation: Ann Intern Med. 1991 Sep 1;115(5):343-9
references.pmid: 1863023
references.citation: Clin Infect Dis. 2011 Feb 1;52(3):378-86
references.pmid: 21217185
references.citation: J Huazhong Univ Sci Technolog Med Sci. 2008 Apr;28(2):194-6
references.pmid: 18480996
references.citation: Am J Cardiol. 2006 Oct 1;98(7):973-7
references.pmid: 16996886
references.citation: J Am Soc Echocardiogr. 2002 Feb;15(2):167-84
references.pmid: 11836492
references.citation: Cardiovasc Ultrasound. 2007 Aug 30;5:27
references.pmid: 17760964
references.citation: Am J Physiol Heart Circ Physiol. 2006 Apr;290(4):H1528-33
references.pmid: 16284226
references.citation: J Am Coll Cardiol. 2009 Apr 28;53(17):1573-619
references.pmid: 19389575
references.citation: Wien Klin Wochenschr. 2008;120(3-4):77-87
references.pmid: 18322768
references.citation: Prog Cardiovasc Dis. 1998 Jan-Feb;40(4):289-308
references.pmid: 9449956
references.citation: J Am Soc Echocardiogr. 2010 Aug;23(8):823-31
references.pmid: 20646910
references.citation: AIDS. 2012 Mar 27;26(6):731-40
references.pmid: 22210636
references.citation: AIDS. 2012 Sep 24;26(15):1967-9
references.pmid: 22781217
references.citation: J Am Coll Cardiol. 1998 Nov;32(5):1486-588
references.pmid: 9809971
references.citation: Circulation. 2008 Mar 18;117(11):1436-48
references.pmid: 18347220
references.citation: AIDS. 2012 Jul 17;26(11):1387-92
references.pmid: 22526521
references.citation: Am J Cardiol. 2006 Sep 1;98(5):699-704
references.pmid: 16923465
references.citation: Am J Cardiol. 2000 Apr 15;85(8):939-44
references.pmid: 10760330
references.citation: HIV Med. 2008 Aug;9(7):550-6
references.pmid: 18557952
references.citation: Br Heart J. 1992 Dec;68(6):549-53
references.pmid: 1334683
references.citation: Am J Respir Crit Care Med. 2006 Nov 1;174(9):1034-41
references.pmid: 16888289
references.citation: J Am Soc Echocardiogr. 1996 Nov-Dec;9(6):838-47
references.pmid: 8943444
references.citation: Chest. 2011 Jun;139(6):1299-1309
references.pmid: 21148241
references.citation: J Heart Lung Transplant. 2000 Feb;19(2):145-54
references.pmid: 10703690