Comprehensive cardiac magnetic resonance imaging and spectroscopy reveal a high burden of myocardial disease in HIV patients

Cameron J. Holloway, Ntobeko Ntusi, Joseph Suttie, Masliza Mahmod, Emma Wainwright, Genevieve Clutton, Gemma Hancock, Philip Beak, Abdelouahid Tajar, Stefan K. Piechnik, Jurgen E. Schneider, Brian Angus, Kieran Clarke, Lucy Dorrell, Stefan Neubauer

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Abstract

BACKGROUND - : HIV infection continues to be endemic worldwide. Although treatments are successful, it remains controversial whether patients receiving optimal therapy have structural, functional, or biochemical cardiac abnormalities that may underlie their increased cardiac morbidity and mortality. The purpose of this study was to characterize myocardial abnormalities in a contemporary group of HIV-infected individuals undergoing combination antiretroviral therapy. METHODS AND RESULTS - : Volunteers with HIV who were undergoing combination antiretroviral therapy and age-matched control subjects without a history of cardiovascular disease underwent cardiac magnetic resonance imaging and spectroscopy for the determination of cardiac function, myocardial fibrosis, and myocardial lipid content. A total of 129 participants were included in this analysis. Compared with age-matched control subjects (n=39; 30.23%), HIV-infected subjects undergoing combination antiretroviral therapy (n=90; 69.77%) had 47% higher median myocardial lipid levels (P <0.003) and 74% higher median plasma triglyceride levels (both P<0.001). Myocardial fibrosis, predominantly in the basal inferolateral wall of the left ventricle, was observed in 76% of HIV-infected subjects compared with 13% of control subjects (P<0.001). Peak myocardial systolic and diastolic longitudinal strain were also lower in HIV-infected individuals than in control subjects and remained statistically significant after adjustment for available confounders. CONCLUSIONS - : Comprehensive cardiac imaging revealed cardiac steatosis, alterations in cardiac function, and a high prevalence of myocardial fibrosis in a contemporary group of asymptomatic HIV-infected subjects undergoing combination antiretroviral therapy. Cardiac steatosis and fibrosis may underlie cardiac dysfunction and increased cardiovascular morbidity and mortality in subjects with HIV.

Original languageEnglish
Pages (from-to)814-822
Number of pages9
JournalCirculation
Volume128
Issue number8
DOIs
Publication statusPublished - 20 Aug 2013
Externally publishedYes

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Cardiomyopathies
Magnetic Resonance Spectroscopy
Magnetic Resonance Imaging
HIV
Fibrosis
Therapeutics
Morbidity
Lipids
Mortality
Heart Ventricles
HIV Infections
Volunteers
Triglycerides
Cardiovascular Diseases

Keywords

  • fibrosis
  • heart function tests
  • HIV-1
  • imaging, diagnostic
  • myocardial fibrosis

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Holloway, C. J., Ntusi, N., Suttie, J., Mahmod, M., Wainwright, E., Clutton, G., ... Neubauer, S. (2013). Comprehensive cardiac magnetic resonance imaging and spectroscopy reveal a high burden of myocardial disease in HIV patients. Circulation, 128(8), 814-822. https://doi.org/10.1161/CIRCULATIONAHA.113.001719

Comprehensive cardiac magnetic resonance imaging and spectroscopy reveal a high burden of myocardial disease in HIV patients. / Holloway, Cameron J.; Ntusi, Ntobeko; Suttie, Joseph; Mahmod, Masliza; Wainwright, Emma; Clutton, Genevieve; Hancock, Gemma; Beak, Philip; Tajar, Abdelouahid; Piechnik, Stefan K.; Schneider, Jurgen E.; Angus, Brian; Clarke, Kieran; Dorrell, Lucy; Neubauer, Stefan.

In: Circulation, Vol. 128, No. 8, 20.08.2013, p. 814-822.

Research output: Contribution to journalArticle

Holloway, CJ, Ntusi, N, Suttie, J, Mahmod, M, Wainwright, E, Clutton, G, Hancock, G, Beak, P, Tajar, A, Piechnik, SK, Schneider, JE, Angus, B, Clarke, K, Dorrell, L & Neubauer, S 2013, 'Comprehensive cardiac magnetic resonance imaging and spectroscopy reveal a high burden of myocardial disease in HIV patients', Circulation, vol. 128, no. 8, pp. 814-822. https://doi.org/10.1161/CIRCULATIONAHA.113.001719
Holloway, Cameron J. ; Ntusi, Ntobeko ; Suttie, Joseph ; Mahmod, Masliza ; Wainwright, Emma ; Clutton, Genevieve ; Hancock, Gemma ; Beak, Philip ; Tajar, Abdelouahid ; Piechnik, Stefan K. ; Schneider, Jurgen E. ; Angus, Brian ; Clarke, Kieran ; Dorrell, Lucy ; Neubauer, Stefan. / Comprehensive cardiac magnetic resonance imaging and spectroscopy reveal a high burden of myocardial disease in HIV patients. In: Circulation. 2013 ; Vol. 128, No. 8. pp. 814-822.
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abstract = "BACKGROUND - : HIV infection continues to be endemic worldwide. Although treatments are successful, it remains controversial whether patients receiving optimal therapy have structural, functional, or biochemical cardiac abnormalities that may underlie their increased cardiac morbidity and mortality. The purpose of this study was to characterize myocardial abnormalities in a contemporary group of HIV-infected individuals undergoing combination antiretroviral therapy. METHODS AND RESULTS - : Volunteers with HIV who were undergoing combination antiretroviral therapy and age-matched control subjects without a history of cardiovascular disease underwent cardiac magnetic resonance imaging and spectroscopy for the determination of cardiac function, myocardial fibrosis, and myocardial lipid content. A total of 129 participants were included in this analysis. Compared with age-matched control subjects (n=39; 30.23{\%}), HIV-infected subjects undergoing combination antiretroviral therapy (n=90; 69.77{\%}) had 47{\%} higher median myocardial lipid levels (P <0.003) and 74{\%} higher median plasma triglyceride levels (both P<0.001). Myocardial fibrosis, predominantly in the basal inferolateral wall of the left ventricle, was observed in 76{\%} of HIV-infected subjects compared with 13{\%} of control subjects (P<0.001). Peak myocardial systolic and diastolic longitudinal strain were also lower in HIV-infected individuals than in control subjects and remained statistically significant after adjustment for available confounders. CONCLUSIONS - : Comprehensive cardiac imaging revealed cardiac steatosis, alterations in cardiac function, and a high prevalence of myocardial fibrosis in a contemporary group of asymptomatic HIV-infected subjects undergoing combination antiretroviral therapy. Cardiac steatosis and fibrosis may underlie cardiac dysfunction and increased cardiovascular morbidity and mortality in subjects with HIV.",
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AU - Holloway, Cameron J.

AU - Ntusi, Ntobeko

AU - Suttie, Joseph

AU - Mahmod, Masliza

AU - Wainwright, Emma

AU - Clutton, Genevieve

AU - Hancock, Gemma

AU - Beak, Philip

AU - Tajar, Abdelouahid

AU - Piechnik, Stefan K.

AU - Schneider, Jurgen E.

AU - Angus, Brian

AU - Clarke, Kieran

AU - Dorrell, Lucy

AU - Neubauer, Stefan

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Y1 - 2013/8/20

N2 - BACKGROUND - : HIV infection continues to be endemic worldwide. Although treatments are successful, it remains controversial whether patients receiving optimal therapy have structural, functional, or biochemical cardiac abnormalities that may underlie their increased cardiac morbidity and mortality. The purpose of this study was to characterize myocardial abnormalities in a contemporary group of HIV-infected individuals undergoing combination antiretroviral therapy. METHODS AND RESULTS - : Volunteers with HIV who were undergoing combination antiretroviral therapy and age-matched control subjects without a history of cardiovascular disease underwent cardiac magnetic resonance imaging and spectroscopy for the determination of cardiac function, myocardial fibrosis, and myocardial lipid content. A total of 129 participants were included in this analysis. Compared with age-matched control subjects (n=39; 30.23%), HIV-infected subjects undergoing combination antiretroviral therapy (n=90; 69.77%) had 47% higher median myocardial lipid levels (P <0.003) and 74% higher median plasma triglyceride levels (both P<0.001). Myocardial fibrosis, predominantly in the basal inferolateral wall of the left ventricle, was observed in 76% of HIV-infected subjects compared with 13% of control subjects (P<0.001). Peak myocardial systolic and diastolic longitudinal strain were also lower in HIV-infected individuals than in control subjects and remained statistically significant after adjustment for available confounders. CONCLUSIONS - : Comprehensive cardiac imaging revealed cardiac steatosis, alterations in cardiac function, and a high prevalence of myocardial fibrosis in a contemporary group of asymptomatic HIV-infected subjects undergoing combination antiretroviral therapy. Cardiac steatosis and fibrosis may underlie cardiac dysfunction and increased cardiovascular morbidity and mortality in subjects with HIV.

AB - BACKGROUND - : HIV infection continues to be endemic worldwide. Although treatments are successful, it remains controversial whether patients receiving optimal therapy have structural, functional, or biochemical cardiac abnormalities that may underlie their increased cardiac morbidity and mortality. The purpose of this study was to characterize myocardial abnormalities in a contemporary group of HIV-infected individuals undergoing combination antiretroviral therapy. METHODS AND RESULTS - : Volunteers with HIV who were undergoing combination antiretroviral therapy and age-matched control subjects without a history of cardiovascular disease underwent cardiac magnetic resonance imaging and spectroscopy for the determination of cardiac function, myocardial fibrosis, and myocardial lipid content. A total of 129 participants were included in this analysis. Compared with age-matched control subjects (n=39; 30.23%), HIV-infected subjects undergoing combination antiretroviral therapy (n=90; 69.77%) had 47% higher median myocardial lipid levels (P <0.003) and 74% higher median plasma triglyceride levels (both P<0.001). Myocardial fibrosis, predominantly in the basal inferolateral wall of the left ventricle, was observed in 76% of HIV-infected subjects compared with 13% of control subjects (P<0.001). Peak myocardial systolic and diastolic longitudinal strain were also lower in HIV-infected individuals than in control subjects and remained statistically significant after adjustment for available confounders. CONCLUSIONS - : Comprehensive cardiac imaging revealed cardiac steatosis, alterations in cardiac function, and a high prevalence of myocardial fibrosis in a contemporary group of asymptomatic HIV-infected subjects undergoing combination antiretroviral therapy. Cardiac steatosis and fibrosis may underlie cardiac dysfunction and increased cardiovascular morbidity and mortality in subjects with HIV.

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KW - heart function tests

KW - HIV-1

KW - imaging, diagnostic

KW - myocardial fibrosis

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