title: Increased pericardial fat accumulation is associated with increased intramyocardial lipid content and duration of highly active antiretroviral therapy exposure in patients infected with human immunodeficiency virus: a 3T cardiovascular magnetic resonance feasibility study.
abstract: BACKGROUND
  The aim of the current study was to examine whether the use of highly active antiretroviral therapy (HAART) in patients with HIV is associated with changes in pericardial fat and myocardial lipid content measured by cardiovascular magnetic resonance (CMR).
  
  
  METHODS
  In this prospective case-control study, we compared 27 HIV seropositive (+) male subjects receiving HAART to 22 control male subjects without HIV matched for age, ethnicity and body mass index. All participants underwent CMR imaging for determination of pericardial fat [as volume at the level of the origin of the left main coronary artery (LM) and at the right ventricular free wall] and magnetic resonance spectroscopy (MRS) for evaluation of intramyocardial lipid content (% of fat to water in a single voxel at the interventricular septum). All measurements were made by two experienced readers blinded to the clinical history of the study participants. Two-sample t-test, Spearman's correlation coefficient or Pearson's correlation coefficient and multivariable logistic regression were used for statistical analysis.
  
  
  RESULTS
  Pericardial fat volume at the level of LM origin was higher in HIV (+) subjects (33.4 cm(3) vs. 27.4 cm(3), p = 0.03). On multivariable analysis adjusted for age, Framingham risk score (FRS) and waist/hip ratio, pericardial fat remained significantly associated to HIV-status (OR 1.09, p = 0.047). For both HIV (+) and HIV (-) subjects, pericardial fat volume showed strong correlation with intramyocardial lipid content (r = 0.58, p < 0.0001) and FRS (r = 0.53, p = 0.0002). Among HIV (+) subjects, pericardial fat was significantly higher in patients with lipo-accumulation (37 cm(3) vs. 27.1 cm(3), p = 0.03) and showed significant correlation with duration of both HIV infection (r = 0.5, p = 0.01) and HAART (r = 0.46, p = 0.02).
  
  
  CONCLUSIONS
  Pericardial fat content is increased in HIV (+) subjects on chronic HAART (>5 years), who demonstrate HAART-related lipo-accumulation and prolonged HIV duration of infection. Further investigation is warranted to determine whether increased pericardial fat is associated with higher cardiovascular risk leading to premature cardiovascular events in this patient population.
authors.affiliation: Division of Nuclear Medicine, Department of Imaging & Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. diazzmariana@gmail.com.
authors.forename: Mariana
authors.initials: M
authors.lastname: Diaz-Zamudio
authors.affiliation: Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Damini.dey@cshs.org.
authors.forename: Damini
authors.initials: D
authors.lastname: Dey
authors.affiliation: Department of Medicine, Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA. labt@med.umich.edu.
authors.forename: Troy
authors.initials: T
authors.lastname: LaBounty
authors.affiliation: Diabetes and Obesity Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Michael.nelson@cshs.org.|Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Michael.nelson@cshs.org.
authors.forename: Michael
authors.initials: M
authors.lastname: Nelson
authors.affiliation: Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Zhaoyang.fan@cshs.org.
authors.forename: Zhaoyang
authors.initials: Z
authors.lastname: Fan
authors.affiliation: Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. lidia.szczepaniak@googlemail.com.|Diabetes and Obesity Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. lidia.szczepaniak@googlemail.com.
authors.forename: Lidia S
authors.initials: LS
authors.lastname: Szczepaniak
authors.affiliation: Division of Nuclear Medicine, Department of Imaging & Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. billhsieh2004@gmail.com.
authors.forename: Bill Pei-Chin
authors.initials: BP
authors.lastname: Hsieh
authors.affiliation: Division of Nuclear Medicine, Department of Imaging & Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. dr.r.rajani@gmail.com.
authors.forename: Ronak
authors.initials: R
authors.lastname: Rajani
authors.affiliation: Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Daniel.berman@cshs.org.
authors.forename: Daniel
authors.initials: D
authors.lastname: Berman
authors.affiliation: Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Debiao.li@cshs.org.
authors.forename: Debiao
authors.initials: D
authors.lastname: Li
authors.affiliation: Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Rohan.dharmakumar@cshs.org.
authors.forename: Rohan
authors.initials: R
authors.lastname: Dharmakumar
authors.affiliation: David-Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. David.hardy@gmail.com.
authors.forename: W David
authors.initials: WD
authors.lastname: Hardy
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 8211, Los Angeles, CA, 90048, USA. antonio.conte@cshs.org.
authors.forename: Antonio Hernandez
authors.initials: AH
authors.lastname: Conte
mesh_terms: D000273:Adipose Tissue / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D050154:Adiposity / Q000187:drug effects*; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D016022:Case-Control Studies; D004334:Drug Administration Schedule; D005240:Feasibility Studies; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D050356:Lipid Metabolism / Q000187:drug effects*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology; D016017:Odds Ratio; D010496:Pericardium / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents