Cardiac Magnetic Resonance Reveals Signs of Subclinical Myocardial Inflammation in Asymptomatic HIV-Infected Patients

Julian A Luetkens; Jonas Doerner; Carolynne Schwarze-Zander; Jan-Christian Wasmuth; Christoph Boesecke; Alois M Sprinkart; Frederic C Schmeel; Rami Homsi; Juergen Gieseke; Hans H Schild; Jürgen K Rockstroh; Claas P Naehle

doi:10.1161/CIRCIMAGING.115.004091

Cardiac Magnetic Resonance Reveals Signs of Subclinical Myocardial Inflammation in Asymptomatic HIV-Infected Patients

Circ Cardiovasc Imaging. 2016 Mar;9(3):e004091. doi: 10.1161/CIRCIMAGING.115.004091.

Affiliations

¹ 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.).
² 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.

PMID: 26951603
DOI: 10.1161/CIRCIMAGING.115.004091

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.

Methods and 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.

Keywords: HIV infections; cardiovascular diseases; inflammation; magnetic resonance imaging; myocarditis.

MeSH terms

Adult
Aged
Anti-HIV Agents / therapeutic use
Asymptomatic Diseases
Case-Control Studies
Female
Fibrosis
HIV Infections / complications*
HIV Infections / diagnosis
HIV Infections / drug therapy
Humans
Magnetic Resonance Imaging*
Male
Middle Aged
Myocarditis / diagnosis*
Myocarditis / pathology
Myocarditis / physiopathology
Myocarditis / virology
Myocardium / pathology
Predictive Value of Tests
Prognosis
Prospective Studies
Stroke Volume
Ventricular Function, Left
Viral Load

Substances

Anti-HIV Agents