title: Myocardial and microvascular inflammation/infection in patients with HIV-associated pulmonary artery hypertension.
abstract: BACKGROUND
  Right ventricle compromise affects survival of patients with HIV-associated pulmonary artery hypertension (PAH).
  
  
  METHODS
  Myocardial histology with viral assessment may clarify the mechanism of right ventricular deterioration and provide clues on PAH origin.
  
  
  METHODS
  Fifteen patients with HIV infection, PAH and right ventricular dysfunction underwent cardiac magnetic resonance, catheterization, coronary with ventricular angiography and biventricular endomyocardial biopsy. Endothelial expression of HLA-DR, ICAM-1, E-selectin and VCAM-1 was semi-quantitatively evaluated. PCR for HIV, hepatitis C virus, human herpes virus-6, human herpes virus-8, Epstein-Barr virus, adenovirus, cytomegalovirus, enterovirus, influenza A/B and parvovirus B19 was performed. In PCR-positive hearts, viral protein adenovirus-1 and TORDJI-22 were assessed by immunohistology.
  
  
  RESULTS
  New York Heart Association class was 2.4 ± 0.5, mean pulmonary artery pressure 49.93 ± 10.15 mmHg and wedge pressure 9.5 ± 2.19 mmHg. Coronaries were normal with slow flow. Left ventricular and/or right ventricular micro-aneurysms were seen in eight patients. Cardiac magnetic resonance documented increased right ventricular end-diastolic volume with reduced ejection fraction, normal left ventricular end-diastolic volume and left ventricular ejection fraction. Subepicardial/mesocardial oedema and delayed enhancement in the inter-ventricular junction and/or left ventricular inferolateral wall was detected in eight patients. Histology showed active lymphocytic myocarditis in 12 patients, with microvasculitis in three. Endothelial adhesion molecules were over-expressed in all patients. PCR was positive in four patients for hepatitis C virus and in two for adenovirus, and viruses localized both in cardiomyocytes and endothelial cells.
  
  
  CONCLUSIONS
  Inflammation/infection of myocardium and intramural vessels is detectable in patients with HIV-associated PAH. It may adversely affect right ventricular function and have a role in the compromised pulmonary circulation.
authors.affiliation: aCardiovascular, Respiratory, Nefrologic, Anestesiologic and Geriatric Sciences Department, La Sapienza University bCellular and Molecular Cardiology Lab, IRCCS L. Spallanzani cInfectious Disease Department, IRCCS L. Spallanzani dRadiology Department, La Sapienza University, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Frustaci
authors.forename: Nicola
authors.initials: N
authors.lastname: Petrosillo
authors.forename: Dario
authors.initials: D
authors.lastname: Vizza
authors.forename: Marco
authors.initials: M
authors.lastname: Francone
authors.forename: Roberto
authors.initials: R
authors.lastname: Badagliacca
authors.forename: Romina
authors.initials: R
authors.lastname: Verardo
authors.forename: Francesco
authors.initials: F
authors.lastname: Fedele
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ippolito
authors.forename: Cristina
authors.initials: C
authors.lastname: Chimenti
mesh_terms: D000328:Adult; D060085:Coinfection / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000473:pathology*; D008297:Male; D055806:Microvessels / Q000473:pathology; D008875:Middle Aged; D009205:Myocarditis / Q000473:pathology*; D009206:Myocardium / Q000473:pathology; D014657:Vasculitis / Q000473:pathology*; D014780:Viruses / Q000145:classification / Q000302:isolation & purification*