Right and left sided cardiac function in HIV patients on anti-retroviral therapy: a cine magnetic resonance imaging study

Background

Numerous studies have found impaired right and left ventricular function in HIV patients. However, most studies are from the era before the introduction of highly active antiretroviral therapy (HAART) and only a few studies have been performed on patients on HAART. In these studies, predominantly echocardiography has been used to assess cardiac function. The aim of the present study was to determine right and left ventricular function in HIV patients on HAART with cine magnetic resonance imaging (MRI) which is a more precise method than echocardiography.

Methods

Thirty-nine well-treated HIV-1 infected patients on HAART with no clinical evidence of cardiac disease were included. Mean age was 48.4 +/- 9 years and mean HIV duration was 179.4 +/- 78.6 months. All patients underwent MRI and had right (RVEF) and left ventricle ejection fraction (LVEF), as well as right (RVEDVI) and left ventricle end diastolic volume index (LVEDVI) measured. Thirty-three age and sex matched controls were included to establish reference values of the MRI measurements. The reference values were defined as mean +/- two standard deviations. When comparing the study group and the control group, independent samples t-test was used. Background parameters are presented as mean +/- s.d. and results are presented as mean +/- SEM.

Results

Compared with controls, the HIV group on average had reduced LVEF (64.9 +/- 1.1% vs. 70.4 +/- 1.5%; p < 0.01) and increased RVEDVI (75.5 +/- 2.2 mL/m² vs. 68.1 +/- 3.0 mL/m²; p < 0.05). RVEF was not significantly reduced (56.5 +/- 1.1% vs. 59.3 +/- 1.1%; NS) nor was LVEDVI significantly increased (64.6 +/- 2.1 mL/m² vs. 58.3 +/- 2.8 mL/m²; NS). Two HIV patients (5%) had marginally reduced LVEF compared to the lower reference value of 53.3%, and one patient (3%) had marginally reduced RVEF compared to the lower reference value of 47.4%. Four patients (10%) had increased LVEDVI compared to the upper reference value of 87.9 mL/m², and two patients (5%) had increased RVEDVI compared to the upper reference value of 98.8 mL/m².

Conclusion

No major cardiac dysfunction is present in well treated HIV patients. However, subclinical functional abnormalities are present in both right and left ventricle in HIV patients, even though they are well-treated on HAART.