title: Abnormal Myocardial Function Is Related to Myocardial Steatosis and Diffuse Myocardial Fibrosis in HIV-Infected Adults.
abstract: BACKGROUND
  Impaired cardiac function persists in the era of effective human immunodeficiency virus (HIV) therapy, although the etiology is unclear. We used magnetic resonance imaging (MRI) to measure intramyocardial lipid levels and fibrosis as possible contributors to HIV-associated myocardial dysfunction.
  
  
  METHODS
  A cross-sectional study of 95 HIV-infected and 30 matched-healthy adults, without known cardiovascular disease (CVD) was completed. Intramyocardial lipid levels, myocardial fibrosis, and cardiac function (measured on the basis of strain) were quantified by MRI.
  
  
  RESULTS
  Systolic function was significantly decreased in HIV-infected subjects as compared to controls (mean radial strain [±SD], 21.7 ± 8.6% vs 30.5 ± 14.2%; P = .004). Intramyocardial lipid level and fibrosis index were both increased in HIV-infected subjects as compared to controls (P ≤ .04 for both) and correlated with the degree of myocardial dysfunction measured by strain parameters. Intramyocardial lipid levels correlated positively with antiretroviral therapy duration and visceral adiposity. Further, impaired myocardial function was strongly correlated with increased monocyte chemoattractant protein 1 levels (r = 0.396, P = .0002) and lipopolysaccharide binding protein levels (r = 0.25, P = .02).
  
  
  CONCLUSIONS
  HIV-infected adults have reduced myocardial function as compared to controls in the absence of known CVD. Decreased cardiac function was associated with abnormal myocardial tissue composition characterized by increased lipid levels and diffuse myocardial fibrosis. Metabolic alterations related to antiretroviral therapy and chronic inflammation may be important targets for optimizing long-term cardiovascular health in HIV-infected individuals.
authors.affiliation: Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases.
authors.forename: Diana K
authors.initials: DK
authors.lastname: Thiara
authors.affiliation: Radiology and Imaging Sciences, Clinical Center.
authors.forename: Chia Ying
authors.initials: CY
authors.lastname: Liu
authors.affiliation: Radiology and Imaging Sciences, Clinical Center Medical Scientist Training Program, University of Alabama at Birmingham.
authors.forename: Fabio
authors.initials: F
authors.lastname: Raman
authors.affiliation: Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Mangat
authors.affiliation: Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland.
authors.forename: Julia B
authors.initials: JB
authors.lastname: Purdy
authors.affiliation: Department of Pediatrics, Seattle Children's Hospital/University of Washington School of Medicine.
authors.forename: Horacio A
authors.initials: HA
authors.lastname: Duarte
authors.affiliation: Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases.
authors.forename: Nancyanne
authors.initials: N
authors.lastname: Schmidt
authors.affiliation: Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases.
authors.forename: Jamie
authors.initials: J
authors.lastname: Hur
authors.affiliation: Oregon Health and Science University, Knight Cardiovascular Institute, Portland.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Sibley
authors.affiliation: Radiology and Imaging Sciences, Clinical Center.
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.affiliation: Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases.
authors.forename: Colleen
authors.initials: C
authors.lastname: Hadigan
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D005355:Fibrosis / Q000473:pathology*; D015658:HIV Infections / Q000150:complications*; D006331:Heart Diseases / Q000473:pathology* / Q000503:physiopathology*; D006334:Heart Function Tests; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*
keywords: HIV; antiretroviral therapy; intramyocardial lipid; magnetic resonance spectroscopy; myocardial strain