title: HIV-1-Related Cardiovascular Disease Is Associated With Chronic Inflammation, Frequent Pericardial Effusions, and Probable Myocardial Edema.
abstract: BACKGROUND
  Patients with treated HIV infection have clear survival benefits although with increased cardiac morbidity and mortality. Mechanisms of heart disease may be partly related to untreated chronic inflammation. Cardiovascular magnetic resonance imaging allows a comprehensive assessment of myocardial structure, function, and tissue characterization. We investigated, using cardiovascular magnetic resonance, subclinical inflammation and myocardial disease in asymptomatic HIV-infected individuals.
  
  
  RESULTS
  Myocardial structure and function were assessed using cardiovascular magnetic resonance at 1.5-T in treated HIV-infected individuals without known cardiovascular disease (n=103; mean age, 45±10 years) compared with healthy controls (n=92; mean age, 44±10 years). Assessments included left ventricular volumes, ejection fraction, strain, regional systolic, diastolic function, native T1 mapping, edema, and gadolinium enhancement. Compared with controls, subjects with HIV infection had 6% lower left ventricular ejection fraction (P<0.001), 7% higher myocardial mass (P=0.02), 29% lower peak diastolic strain rate (P<0.001), 4% higher short-tau inversion recovery values (P=0.02), and higher native T1 values (969 versus 956 ms in controls; P=0.01). Pericardial effusions and myocardial fibrosis were 3 and 4× more common, respectively, in subjects with HIV infection (both P<0.001).
  
  
  CONCLUSIONS
  Treated HIV infection is associated with changes in myocardial structure and function in addition to higher rates of subclinical myocardial edema and fibrosis and frequent pericardial effusions. Chronic systemic inflammation in HIV, which involves the myocardium and pericardium, may explain the high rate of myocardial fibrosis and increased cardiac dysfunction in people living with HIV.
authors.affiliation: From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom (N.N., S.P., V.F., T.K., S.N., C.H.); Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (N.N., M.B.); Department of Cardiology, St.Vincent's Hospital, Darlinghurst, New South Wales, Australia (E.O., S.E., C.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia (E.O., S.E., C.H.); Nuffield Department of Medicine, Weatherall Institute of Molecular Medicine, University of Oxford and John Radcliffe Hospital, Oxford, United Kingdom (L.D., E.W., G.C., G.H.); Department of Physiology, Anatomy and Genetics (P.C., K.C., C.H.) and Oxford NIHR Biomedical Research Centre (S.N., C.H.), University of Oxford, Oxford, United Kingdom; and 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (T.K.).
authors.forename: Ntobeko
authors.initials: N
authors.lastname: Ntusi
authors.affiliation: From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom (N.N., S.P., V.F., T.K., S.N., C.H.); Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (N.N., M.B.); Department of Cardiology, St.Vincent's Hospital, Darlinghurst, New South Wales, Australia (E.O., S.E., C.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia (E.O., S.E., C.H.); Nuffield Department of Medicine, Weatherall Institute of Molecular Medicine, University of Oxford and John Radcliffe Hospital, Oxford, United Kingdom (L.D., E.W., G.C., G.H.); Department of Physiology, Anatomy and Genetics (P.C., K.C., C.H.) and Oxford NIHR Biomedical Research Centre (S.N., C.H.), University of Oxford, Oxford, United Kingdom; and 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (T.K.).
authors.forename: Eoin
authors.initials: E
authors.lastname: O'Dwyer
authors.affiliation: From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom (N.N., S.P., V.F., T.K., S.N., C.H.); Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (N.N., M.B.); Department of Cardiology, St.Vincent's Hospital, Darlinghurst, New South Wales, Australia (E.O., S.E., C.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia (E.O., S.E., C.H.); Nuffield Department of Medicine, Weatherall Institute of Molecular Medicine, University of Oxford and John Radcliffe Hospital, Oxford, United Kingdom (L.D., E.W., G.C., G.H.); Department of Physiology, Anatomy and Genetics (P.C., K.C., C.H.) and Oxford NIHR Biomedical Research Centre (S.N., C.H.), University of Oxford, Oxford, United Kingdom; and 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (T.K.).
authors.forename: Lucy
authors.initials: L
authors.lastname: Dorrell
authors.affiliation: From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom (N.N., S.P., V.F., T.K., S.N., C.H.); Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (N.N., M.B.); Department of Cardiology, St.Vincent's Hospital, Darlinghurst, New South Wales, Australia (E.O., S.E., C.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia (E.O., S.E., C.H.); Nuffield Department of Medicine, Weatherall Institute of Molecular Medicine, University of Oxford and John Radcliffe Hospital, Oxford, United Kingdom (L.D., E.W., G.C., G.H.); Department of Physiology, Anatomy and Genetics (P.C., K.C., C.H.) and Oxford NIHR Biomedical Research Centre (S.N., C.H.), University of Oxford, Oxford, United Kingdom; and 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (T.K.).
authors.forename: Emma
authors.initials: E
authors.lastname: Wainwright
authors.affiliation: From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom (N.N., S.P., V.F., T.K., S.N., C.H.); Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (N.N., M.B.); Department of Cardiology, St.Vincent's Hospital, Darlinghurst, New South Wales, Australia (E.O., S.E., C.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia (E.O., S.E., C.H.); Nuffield Department of Medicine, Weatherall Institute of Molecular Medicine, University of Oxford and John Radcliffe Hospital, Oxford, United Kingdom (L.D., E.W., G.C., G.H.); Department of Physiology, Anatomy and Genetics (P.C., K.C., C.H.) and Oxford NIHR Biomedical Research Centre (S.N., C.H.), University of Oxford, Oxford, United Kingdom; and 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (T.K.).
authors.forename: Stefan
authors.initials: S
authors.lastname: Piechnik
authors.affiliation: From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom (N.N., S.P., V.F., T.K., S.N., C.H.); Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (N.N., M.B.); Department of Cardiology, St.Vincent's Hospital, Darlinghurst, New South Wales, Australia (E.O., S.E., C.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia (E.O., S.E., C.H.); Nuffield Department of Medicine, Weatherall Institute of Molecular Medicine, University of Oxford and John Radcliffe Hospital, Oxford, United Kingdom (L.D., E.W., G.C., G.H.); Department of Physiology, Anatomy and Genetics (P.C., K.C., C.H.) and Oxford NIHR Biomedical Research Centre (S.N., C.H.), University of Oxford, Oxford, United Kingdom; and 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (T.K.).
authors.forename: Genevieve
authors.initials: G
authors.lastname: Clutton
authors.affiliation: From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom (N.N., S.P., V.F., T.K., S.N., C.H.); Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (N.N., M.B.); Department of Cardiology, St.Vincent's Hospital, Darlinghurst, New South Wales, Australia (E.O., S.E., C.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia (E.O., S.E., C.H.); Nuffield Department of Medicine, Weatherall Institute of Molecular Medicine, University of Oxford and John Radcliffe Hospital, Oxford, United Kingdom (L.D., E.W., G.C., G.H.); Department of Physiology, Anatomy and Genetics (P.C., K.C., C.H.) and Oxford NIHR Biomedical Research Centre (S.N., C.H.), University of Oxford, Oxford, United Kingdom; and 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (T.K.).
authors.forename: Gemma
authors.initials: G
authors.lastname: Hancock
authors.affiliation: From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom (N.N., S.P., V.F., T.K., S.N., C.H.); Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (N.N., M.B.); Department of Cardiology, St.Vincent's Hospital, Darlinghurst, New South Wales, Australia (E.O., S.E., C.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia (E.O., S.E., C.H.); Nuffield Department of Medicine, Weatherall Institute of Molecular Medicine, University of Oxford and John Radcliffe Hospital, Oxford, United Kingdom (L.D., E.W., G.C., G.H.); Department of Physiology, Anatomy and Genetics (P.C., K.C., C.H.) and Oxford NIHR Biomedical Research Centre (S.N., C.H.), University of Oxford, Oxford, United Kingdom; and 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (T.K.).
authors.forename: Vanessa
authors.initials: V
authors.lastname: Ferreira
authors.affiliation: From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom (N.N., S.P., V.F., T.K., S.N., C.H.); Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (N.N., M.B.); Department of Cardiology, St.Vincent's Hospital, Darlinghurst, New South Wales, Australia (E.O., S.E., C.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia (E.O., S.E., C.H.); Nuffield Department of Medicine, Weatherall Institute of Molecular Medicine, University of Oxford and John Radcliffe Hospital, Oxford, United Kingdom (L.D., E.W., G.C., G.H.); Department of Physiology, Anatomy and Genetics (P.C., K.C., C.H.) and Oxford NIHR Biomedical Research Centre (S.N., C.H.), University of Oxford, Oxford, United Kingdom; and 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (T.K.).
authors.forename: Pete
authors.initials: P
authors.lastname: Cox
authors.affiliation: From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom (N.N., S.P., V.F., T.K., S.N., C.H.); Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (N.N., M.B.); Department of Cardiology, St.Vincent's Hospital, Darlinghurst, New South Wales, Australia (E.O., S.E., C.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia (E.O., S.E., C.H.); Nuffield Department of Medicine, Weatherall Institute of Molecular Medicine, University of Oxford and John Radcliffe Hospital, Oxford, United Kingdom (L.D., E.W., G.C., G.H.); Department of Physiology, Anatomy and Genetics (P.C., K.C., C.H.) and Oxford NIHR Biomedical Research Centre (S.N., C.H.), University of Oxford, Oxford, United Kingdom; and 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (T.K.).
authors.forename: Motasim
authors.initials: M
authors.lastname: Badri
authors.affiliation: From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom (N.N., S.P., V.F., T.K., S.N., C.H.); Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (N.N., M.B.); Department of Cardiology, St.Vincent's Hospital, Darlinghurst, New South Wales, Australia (E.O., S.E., C.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia (E.O., S.E., C.H.); Nuffield Department of Medicine, Weatherall Institute of Molecular Medicine, University of Oxford and John Radcliffe Hospital, Oxford, United Kingdom (L.D., E.W., G.C., G.H.); Department of Physiology, Anatomy and Genetics (P.C., K.C., C.H.) and Oxford NIHR Biomedical Research Centre (S.N., C.H.), University of Oxford, Oxford, United Kingdom; and 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (T.K.).
authors.forename: Theodoros
authors.initials: T
authors.lastname: Karamitsos
authors.affiliation: From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom (N.N., S.P., V.F., T.K., S.N., C.H.); Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (N.N., M.B.); Department of Cardiology, St.Vincent's Hospital, Darlinghurst, New South Wales, Australia (E.O., S.E., C.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia (E.O., S.E., C.H.); Nuffield Department of Medicine, Weatherall Institute of Molecular Medicine, University of Oxford and John Radcliffe Hospital, Oxford, United Kingdom (L.D., E.W., G.C., G.H.); Department of Physiology, Anatomy and Genetics (P.C., K.C., C.H.) and Oxford NIHR Biomedical Research Centre (S.N., C.H.), University of Oxford, Oxford, United Kingdom; and 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (T.K.).
authors.forename: Sam
authors.initials: S
authors.lastname: Emmanuel
authors.affiliation: From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom (N.N., S.P., V.F., T.K., S.N., C.H.); Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (N.N., M.B.); Department of Cardiology, St.Vincent's Hospital, Darlinghurst, New South Wales, Australia (E.O., S.E., C.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia (E.O., S.E., C.H.); Nuffield Department of Medicine, Weatherall Institute of Molecular Medicine, University of Oxford and John Radcliffe Hospital, Oxford, United Kingdom (L.D., E.W., G.C., G.H.); Department of Physiology, Anatomy and Genetics (P.C., K.C., C.H.) and Oxford NIHR Biomedical Research Centre (S.N., C.H.), University of Oxford, Oxford, United Kingdom; and 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (T.K.).
authors.forename: Kieran
authors.initials: K
authors.lastname: Clarke
authors.affiliation: From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom (N.N., S.P., V.F., T.K., S.N., C.H.); Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (N.N., M.B.); Department of Cardiology, St.Vincent's Hospital, Darlinghurst, New South Wales, Australia (E.O., S.E., C.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia (E.O., S.E., C.H.); Nuffield Department of Medicine, Weatherall Institute of Molecular Medicine, University of Oxford and John Radcliffe Hospital, Oxford, United Kingdom (L.D., E.W., G.C., G.H.); Department of Physiology, Anatomy and Genetics (P.C., K.C., C.H.) and Oxford NIHR Biomedical Research Centre (S.N., C.H.), University of Oxford, Oxford, United Kingdom; and 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (T.K.).
authors.forename: Stefan
authors.initials: S
authors.lastname: Neubauer
authors.affiliation: From the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom (N.N., S.P., V.F., T.K., S.N., C.H.); Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (N.N., M.B.); Department of Cardiology, St.Vincent's Hospital, Darlinghurst, New South Wales, Australia (E.O., S.E., C.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia (E.O., S.E., C.H.); Nuffield Department of Medicine, Weatherall Institute of Molecular Medicine, University of Oxford and John Radcliffe Hospital, Oxford, United Kingdom (L.D., E.W., G.C., G.H.); Department of Physiology, Anatomy and Genetics (P.C., K.C., C.H.) and Oxford NIHR Biomedical Research Centre (S.N., C.H.), University of Oxford, Oxford, United Kingdom; and 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (T.K.). cholloway@stvincents.com.au.
authors.forename: Cameron
authors.initials: C
authors.lastname: Holloway
mesh_terms: D000328:Adult; D058070:Asymptomatic Diseases; D016022:Case-Control Studies; D002908:Chronic Disease; D003287:Contrast Media; D003430:Cross-Sectional Studies; D003971:Diastole; D004489:Edema, Cardiac / Q000175:diagnosis / Q000503:physiopathology / Q000821:virology*; D005260:Female; D005355:Fibrosis; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000821:virology*; D015497:HIV-1 / Q000472:pathogenicity*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis / Q000503:physiopathology / Q000821:virology*; D009206:Myocardium / Q000473:pathology; D010490:Pericardial Effusion / Q000175:diagnosis / Q000503:physiopathology / Q000821:virology*; D011237:Predictive Value of Tests; D013318:Stroke Volume; D013599:Systole; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media
keywords: HIV-1; HIV-associated cardiovascular disease; cardiac function; endomyocardial fibrosis; magnetic resonance imaging; pericardial effusion