title: Cardiac Magnetic Resonance Reveals Signs of Subclinical Myocardial Inflammation in Asymptomatic HIV-Infected Patients.
abstract: BACKGROUND
  People living with chronic HIV infection are at an increased risk for cardiovascular disease. With this study, we aimed to determine the extent of cardiovascular involvement in asymptomatic HIV-infected patients by a comprehensive cardiac magnetic resonance (CMR) approach.
  
  
  RESULTS
  Asymptomatic patients with chronic HIV infection undergoing combination antiretroviral therapy (n=28) and control subjects (n=22) underwent CMR. HIV-infected patients were successfully controlled for the disease with a consistent plasma viremia of <200 copies/mL (mean CD4(+)-cell count, 475.1±307.9 cells/μL). CMR protocol allowed for the determination of cardiac function, myocardial inflammation, myocardial fibrosis, aortic stiffness, and pericardial fat volume. When compared with healthy controls, HIV-infected patients showed alterations in left ventricular function as demonstrated by a lower ejection fraction (60.9±7.1% versus 65.2±5.5%; P=0.023) and lower global peak systolic longitudinal and circumferential strain values (longitudinal strain, -17.7±3.4% versus -20.2±3.2%, circumferential strain, -21.2±4.6% versus -24.7±5.1%; P<0.001, respectively). CMR parameters indicating myocardial inflammation were elevated in HIV-infected patients (native T1 relaxation times, 1128.3±53.4 ms versus 1086.5±54.5 ms; P=0.009; relative T2 signal intensity ratio, 1.6±0.3 versus 1.4±0.3; P=0.046; early gadolinium enhancement ratio, 3.1±1.2 versus 2.1±0.6; P=0.003). Myocardial fibrosis, predominantly at the subepicardium of the midventricular and basal inferolateral wall, was prevalent in 82.1% of HIV-infected patients, but only in 27.3% of healthy controls (P<0.001).
  
  
  CONCLUSIONS
  Comprehensive CMR revealed a high burden of cardiovascular disease in asymptomatic HIV-infected patients. Subclinical myocardial inflammation as detected by CMR may be a potential precursor of the increased cardiovascular morbidity and mortality observed in patients with chronic HIV infection.
authors.affiliation: From the Department of Radiology (J.A.L., J.D., A.M.S., F.C.S., R.H., J.G., H.H.S., C.P.N.) and Department of Internal Medicine I (C.S.-Z., J.-C.W., C.B., J.K.R.), University of Bonn, Bonn, Germany; Department of Radiology, University Hospital Cologne, Germany (J.D.); and Philips Healthcare, Clinical Science, Hamburg, Germany (J.G.).
authors.forename: Julian A
authors.initials: JA
authors.lastname: Luetkens
authors.affiliation: From the Department of Radiology (J.A.L., J.D., A.M.S., F.C.S., R.H., J.G., H.H.S., C.P.N.) and Department of Internal Medicine I (C.S.-Z., J.-C.W., C.B., J.K.R.), University of Bonn, Bonn, Germany; Department of Radiology, University Hospital Cologne, Germany (J.D.); and Philips Healthcare, Clinical Science, Hamburg, Germany (J.G.).
authors.forename: Jonas
authors.initials: J
authors.lastname: Doerner
authors.affiliation: From the Department of Radiology (J.A.L., J.D., A.M.S., F.C.S., R.H., J.G., H.H.S., C.P.N.) and Department of Internal Medicine I (C.S.-Z., J.-C.W., C.B., J.K.R.), University of Bonn, Bonn, Germany; Department of Radiology, University Hospital Cologne, Germany (J.D.); and Philips Healthcare, Clinical Science, Hamburg, Germany (J.G.).
authors.forename: Carolynne
authors.initials: C
authors.lastname: Schwarze-Zander
authors.affiliation: From the Department of Radiology (J.A.L., J.D., A.M.S., F.C.S., R.H., J.G., H.H.S., C.P.N.) and Department of Internal Medicine I (C.S.-Z., J.-C.W., C.B., J.K.R.), University of Bonn, Bonn, Germany; Department of Radiology, University Hospital Cologne, Germany (J.D.); and Philips Healthcare, Clinical Science, Hamburg, Germany (J.G.).
authors.forename: Jan-Christian
authors.initials: JC
authors.lastname: Wasmuth
authors.affiliation: From the Department of Radiology (J.A.L., J.D., A.M.S., F.C.S., R.H., J.G., H.H.S., C.P.N.) and Department of Internal Medicine I (C.S.-Z., J.-C.W., C.B., J.K.R.), University of Bonn, Bonn, Germany; Department of Radiology, University Hospital Cologne, Germany (J.D.); and Philips Healthcare, Clinical Science, Hamburg, Germany (J.G.).
authors.forename: Christoph
authors.initials: C
authors.lastname: Boesecke
authors.affiliation: From the Department of Radiology (J.A.L., J.D., A.M.S., F.C.S., R.H., J.G., H.H.S., C.P.N.) and Department of Internal Medicine I (C.S.-Z., J.-C.W., C.B., J.K.R.), University of Bonn, Bonn, Germany; Department of Radiology, University Hospital Cologne, Germany (J.D.); and Philips Healthcare, Clinical Science, Hamburg, Germany (J.G.).
authors.forename: Alois M
authors.initials: AM
authors.lastname: Sprinkart
authors.affiliation: From the Department of Radiology (J.A.L., J.D., A.M.S., F.C.S., R.H., J.G., H.H.S., C.P.N.) and Department of Internal Medicine I (C.S.-Z., J.-C.W., C.B., J.K.R.), University of Bonn, Bonn, Germany; Department of Radiology, University Hospital Cologne, Germany (J.D.); and Philips Healthcare, Clinical Science, Hamburg, Germany (J.G.).
authors.forename: Frederic C
authors.initials: FC
authors.lastname: Schmeel
authors.affiliation: From the Department of Radiology (J.A.L., J.D., A.M.S., F.C.S., R.H., J.G., H.H.S., C.P.N.) and Department of Internal Medicine I (C.S.-Z., J.-C.W., C.B., J.K.R.), University of Bonn, Bonn, Germany; Department of Radiology, University Hospital Cologne, Germany (J.D.); and Philips Healthcare, Clinical Science, Hamburg, Germany (J.G.).
authors.forename: Rami
authors.initials: R
authors.lastname: Homsi
authors.affiliation: From the Department of Radiology (J.A.L., J.D., A.M.S., F.C.S., R.H., J.G., H.H.S., C.P.N.) and Department of Internal Medicine I (C.S.-Z., J.-C.W., C.B., J.K.R.), University of Bonn, Bonn, Germany; Department of Radiology, University Hospital Cologne, Germany (J.D.); and Philips Healthcare, Clinical Science, Hamburg, Germany (J.G.).
authors.forename: Juergen
authors.initials: J
authors.lastname: Gieseke
authors.affiliation: From the Department of Radiology (J.A.L., J.D., A.M.S., F.C.S., R.H., J.G., H.H.S., C.P.N.) and Department of Internal Medicine I (C.S.-Z., J.-C.W., C.B., J.K.R.), University of Bonn, Bonn, Germany; Department of Radiology, University Hospital Cologne, Germany (J.D.); and Philips Healthcare, Clinical Science, Hamburg, Germany (J.G.).
authors.forename: Hans H
authors.initials: HH
authors.lastname: Schild
authors.affiliation: From the Department of Radiology (J.A.L., J.D., A.M.S., F.C.S., R.H., J.G., H.H.S., C.P.N.) and Department of Internal Medicine I (C.S.-Z., J.-C.W., C.B., J.K.R.), University of Bonn, Bonn, Germany; Department of Radiology, University Hospital Cologne, Germany (J.D.); and Philips Healthcare, Clinical Science, Hamburg, Germany (J.G.).
authors.forename: Jürgen K
authors.initials: JK
authors.lastname: Rockstroh
authors.affiliation: From the Department of Radiology (J.A.L., J.D., A.M.S., F.C.S., R.H., J.G., H.H.S., C.P.N.) and Department of Internal Medicine I (C.S.-Z., J.-C.W., C.B., J.K.R.), University of Bonn, Bonn, Germany; Department of Radiology, University Hospital Cologne, Germany (J.D.); and Philips Healthcare, Clinical Science, Hamburg, Germany (J.G.). cp@naehle.net.
authors.forename: Claas P
authors.initials: CP
authors.lastname: Naehle
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use; D058070:Asymptomatic Diseases; D016022:Case-Control Studies; D005260:Female; D005355:Fibrosis; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000821:virology; D009206:Myocardium / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume; D016277:Ventricular Function, Left; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: HIV infections; cardiovascular diseases; inflammation; magnetic resonance imaging; myocarditis