Assessment of subclinical cardiac dysfunction by speckle-tracking echocardiography among people living with human immunodeficiency virus

Chia-Te Liao; Han Siong Toh; Wei-Ting Chang; Chun-Ting Yang; Zhih-Cherng Chen; Hung-Jen Tang; Carol Strong

doi:10.3389/fcvm.2023.1200418

Assessment of subclinical cardiac dysfunction by speckle-tracking echocardiography among people living with human immunodeficiency virus

Front Cardiovasc Med. 2023 May 23:10:1200418. doi: 10.3389/fcvm.2023.1200418. eCollection 2023.

Authors

Chia-Te Liao^{1

2

3}, Han Siong Toh^{4

5

6}, Wei-Ting Chang^{2

5}, Chun-Ting Yang⁷, Zhih-Cherng Chen², Hung-Jen Tang⁸, Carol Strong¹

Affiliations

¹ Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
² Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
³ Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
⁴ Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan.
⁵ Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁶ Department of Health and Nutrition, Chia Nan University of Pharmacy & Science, Tainan, Taiwan.
⁷ Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁸ Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.

Abstract

Background: People living with HIV (PLWH) have an increased risk of developing cardiovascular diseases (CVD). As speckle-tracking echocardiography (STE) has been used to detect subclinical myocardial abnormalities, this study aims to detect early cardiac impairment among Asian PLWH using STE and to investigate the associated risk factors.

Methods: We consecutively recruited asymptomatic PLWH without previous CVD from a medical center of Taiwan, and their cardiac function was evaluated by conventional echocardiogram and STE. Enrolled PLWH were classified as antiretroviral therapy (ART)-experienced and ART-naive, and multivariable regressions were used to assess the association between myocardial strain and risk factors including traditional CVD and HIV-associated factors.

Results: A total of 181 PLWH (mean age: 36.4 ± 11.4 years, 173 males) were recruited and conventional echocardiogram parameters were within normal ranges. Decreased myocardial strain across the myocardium was found, with a mean left ventricular (LV) global longitudinal strain of -18.7 ± 2.9%. The LV strain in the ART-experienced group (-19.0 ± 2.9%) was significantly better than the ART-naive group (-17.9 ± 2.8%), despite a younger age and lesser CVD risk factors in the ART-naive group. Hypertension [B = 1.92, 95% confidence interval (95% CI) 0.19-3.62, p = 0.029] and ART-naive with both low and high viral loads (VL) (B = 1.09, 95% CI 0.03-2.16, p = 0.047; and B = 2.00, 95% CI, 0.22-3.79, p = 0.029) were significantly associated with reduced myocardial strain.

Conclusion: This is the first and largest cohort using STE to investigate myocardial strain in Asian PLWH. Our results suggest that hypertension and detectable VL are associated with impaired myocardial strain. Thus, timely ART administration with VL suppression and hypertension control are crucial in preventing CVD when making the management parallel with the improved life expectancy of PLWH on ART.

Keywords: HIV/AIDS; cardiovascular disease; myocardial strain; speckle-tracking echocardiogram; subclinical myocardial dysfunction.

Grants and funding

This project was supported by grants from the Ministry of Science and Technology in Taiwan (MOST 111-2314-B-384-003 to C-TL), the Chi Mei Medical Center (CMNCKU11015 to HST), and the Teh-Tzer Study Group for Human Medical Research Foundation (A1091055 to H-JT).