title: Myocardial deformation imaging unmasks subtle left ventricular systolic dysfunction in asymptomatic and treatment-naïve HIV patients.
abstract: BACKGROUND
  Patients infected by the human immunodeficiency virus (HIV) and receiving highly active antiretroviral therapy have a higher incidence of cardiovascular disease than healthy subjects, but little is known about cardiac function in asymptomatic and treatment-naïve patients. We sought to study cardiac function in asymptomatic HIV-infected, treatment-naïve patients.
  
  
  METHODS
  We studied 41 HIV-infected and treatment-naïve patients and 20 age- and sex-matched healthy controls. Patients with cardiac symptoms, history of cardiac disease or NT-proBNP >100 pg/mL were excluded. We addressed cardiac function using standard echocardiography along with tissue Doppler (TDI) measurements, including strain/strain rate assessment.
  
  
  RESULTS
  Standard echocardiographic parameters did not differ between groups, except for transmitral E wave velocity (64.8 ± 14 cm/s in HIV vs 76.1 ± 10 cm/s in controls, p = 0.002). In contrast, TDI mitral and tricuspid annulus s velocity and all strain/strain rate measurements were significantly lower in HIV patients: s lateral, 10.2 ± 2.4/11.3 ± 0.7, p = 0.011; s septal, 8.1 ± 1.6/8.7 ± 0.8, p = 0.045; s tricuspid, 13.4 ± 2.3/14.9 ± 1.3, p = 0.002; strain/strain rate, septal (strain/strain rate, 15.1 ± 5.7/-0.9 ± 0.3, 25.3 ± 1.7/-1.9 ± 0.2, p < 0.001), anterior (16.7 ± 3/-1.0 ± 0.1, 26.7 ± 1.7/-1.9 ± 0.2, p < 0.001), lateral (16.0 ± 6/-1.0 ± 0.1, 27.5 ± 1.8/-2.2 ± 0.3, p < 0.001) and posterior (15.2 ± 5.8/-1.0 ± 0.2, 26.2 ± 1.8/-2.2 ± 0.3, p < 0.001) left ventricular wall.
  
  
  CONCLUSIONS
  HIV infection itself is accompanied by subclinical systolic dysfunction, not apparent to standard echocardiography that can be unmasked though using sensitive echocardiographic techniques.
authors.affiliation: Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Karavidas
authors.affiliation: First Department of Internal Medicine, Athens General Hospital "G. Gennimatas", Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Xylomenos
authors.affiliation: Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece.
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Matzaraki
authors.affiliation: Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Papoutsidakis
authors.affiliation: Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Leventopoulos
authors.affiliation: Heart Failure Unit, Department of Cardiology, Athens University Hospital "Attikon", 1 Rimini St, Haidari, 12461, Athens, Greece. dimitrios_farmakis@yahoo.com.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Farmakis
authors.affiliation: Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Lazaros
authors.affiliation: Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Perpinia
authors.affiliation: Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece.
authors.forename: Sophia
authors.initials: S
authors.lastname: Arapi
authors.affiliation: First Department of Internal Medicine, Athens General Hospital "G. Gennimatas", Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Paisios
authors.affiliation: Heart Failure Unit, Department of Cardiology, Athens University Hospital "Attikon", 1 Rimini St, Haidari, 12461, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Parissis
authors.affiliation: Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece.
authors.forename: Vlasios
authors.initials: V
authors.lastname: Pyrgakis
authors.affiliation: First Department of Internal Medicine, Athens General Hospital "G. Gennimatas", Athens, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Gargalianos
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*
keywords: HIV; Myocardial deformation; Strain; Strain rate; Systolic dysfunction