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Diastolic Dysfunction in Patients With Human Immunodeficiency Virus Receiving Antiretroviral Therapy: Results From the CHART Study.

Publication ,  Journal Article
Butler, J; Greene, SJ; Shah, SH; Shah, SJ; Anstrom, KJ; Kim, RJ; Kalogeropoulos, AP; Velazquez, EJ; Hernandez, AF; Desvigne-Nickens, P ...
Published in: J Card Fail
May 2020

BACKGROUND: Diastolic dysfunction (DD) is common and occurs at an earlier age among human immunodeficiency virus-infected (HIV+) individuals, but the mechanisms and consequences of DD among HIV+ individuals are unclear. METHODS AND RESULTS: The Characterization of Heart Function on Antiretroviral Therapy (CHART) study was a multicenter cross-sectional case-control study of treated and virally suppressed HIV+ individuals with (DD+) and without DD (DD-). All patients had normal ejection fraction (>50%), no significant valvular disease, and no history of coronary revascularization or persistent atrial fibrillation. Overall, 94 DD+ and 101 DD- patients were included. DD+ patients were older with higher body mass index (BMI) and more likely to have hypertension, renal dysfunction, and dyslipidemia. Groups were similar with respect to sex, race, CD4 count, and HIV RNA copies. N-terminal pro-B-type natriuretic peptide levels (median 36 [23, 85] vs 26 [12, 49] pg/mL, P < .01) and high-sensitivity troponin I (3.6 [2.6, 5.1] vs 2.5 [1.8, 3.5] pg/mL, P < .01) were higher among DD+ patients. The latter had similar left atrial size, but increased stiffness (conduit strain: 23.5 [17.5, 36.9] vs 30.0 [22.9, 37.0], P < .01) and impaired relaxation (reservoir strain: 39.7 [32.0, 58.0] vs 45.9 [37.0, 60.6], P = .04). On cardiac magnetic resonance, the prevalence of focal fibrosis was higher among DD+ patients (19.0% vs 5.3%, P < .01). DD+ patients demonstrated higher levels of carboxyl-terminal telopeptide of collagen type I (P = .04), and trends toward higher interleukin-6 and oxidized low-density lipoprotein levels (P ≤ .08). Kansas City Cardiomyopathy Questionnaire physical limitation (87.1±21.4 vs 93.1±18.1, P = .01) and symptom frequency scores were lower among DD+ patients (86.0±21.5 vs 92.5±16.8, P = .01). CONCLUSIONS: In this contemporary HIV+ population receiving antiretroviral therapy, DD was associated with multiple alterations in cardiac structure and function, including myocardial fibrosis and left atrial abnormalities, and worse quality of life. Further studies are needed to assess longitudinal changes in these parameters and their potential as therapeutic targets to prevent progressive cardiac remodeling and dysfunction in HIV.

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Published In

J Card Fail

DOI

EISSN

1532-8414

Publication Date

May 2020

Volume

26

Issue

5

Start / End Page

371 / 380

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Quality of Life
  • Humans
  • Heart Failure
  • Heart Atria
  • HIV Infections
  • HIV
  • Cross-Sectional Studies
  • Case-Control Studies
  • Cardiovascular System & Hematology
 

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Butler, J., Greene, S. J., Shah, S. H., Shah, S. J., Anstrom, K. J., Kim, R. J., … Braunwald, E. (2020). Diastolic Dysfunction in Patients With Human Immunodeficiency Virus Receiving Antiretroviral Therapy: Results From the CHART Study. J Card Fail, 26(5), 371–380. https://doi.org/10.1016/j.cardfail.2019.10.011
Butler, Javed, Stephen J. Greene, Svati H. Shah, Sanjiv J. Shah, Kevin J. Anstrom, Raymond J. Kim, Andreas P. Kalogeropoulos, et al. “Diastolic Dysfunction in Patients With Human Immunodeficiency Virus Receiving Antiretroviral Therapy: Results From the CHART Study.J Card Fail 26, no. 5 (May 2020): 371–80. https://doi.org/10.1016/j.cardfail.2019.10.011.
Butler J, Greene SJ, Shah SH, Shah SJ, Anstrom KJ, Kim RJ, et al. Diastolic Dysfunction in Patients With Human Immunodeficiency Virus Receiving Antiretroviral Therapy: Results From the CHART Study. J Card Fail. 2020 May;26(5):371–80.
Butler, Javed, et al. “Diastolic Dysfunction in Patients With Human Immunodeficiency Virus Receiving Antiretroviral Therapy: Results From the CHART Study.J Card Fail, vol. 26, no. 5, May 2020, pp. 371–80. Pubmed, doi:10.1016/j.cardfail.2019.10.011.
Butler J, Greene SJ, Shah SH, Shah SJ, Anstrom KJ, Kim RJ, Kalogeropoulos AP, Velazquez EJ, Hernandez AF, Desvigne-Nickens P, Scherzer R, Hsue PY, Braunwald E. Diastolic Dysfunction in Patients With Human Immunodeficiency Virus Receiving Antiretroviral Therapy: Results From the CHART Study. J Card Fail. 2020 May;26(5):371–380.
Journal cover image

Published In

J Card Fail

DOI

EISSN

1532-8414

Publication Date

May 2020

Volume

26

Issue

5

Start / End Page

371 / 380

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Quality of Life
  • Humans
  • Heart Failure
  • Heart Atria
  • HIV Infections
  • HIV
  • Cross-Sectional Studies
  • Case-Control Studies
  • Cardiovascular System & Hematology