LOS ANGELES — Human immunodeficiency virus (HIV) infection is known to be associated with subclinical cardiomyopathy, diastolic dysfunction and increased risk of cardiovascular death.
The relationship between left atrial (LA) mechanics and left ventricular (LV) diastolic function is not well understood, however, in people living with HIV (PLWH) compared to HIV-uninfected (HIV-) controls, according to a recent report in the American Journal of Cardiology.1
The David Geffen School of Medicine at UCLA-led study included participation from VAMCs in Los Angeles; West Haven, CT; Nashville, TN; Bronx, NY; Dallas and Pittsburgh. The team conducted a multicenter, cross-sectional cohort analysis using the HIV Cardiovascular Disease substudy of the Veterans Aging Cohort Study database. The goal was to examine a cohort of PLWH and HIV-veterans without known cardiovascular disease.
To do that, researchers identified 277 subjects—180 PLWH, 97 without HIV—with echocardiograms. LV and LA phasic strain were derived, and diastolic function was evaluated. The study team assessed the relationship between LA strain, LV strain, and the degree of diastolic dysfunction, using analysis of variance and ordinal logistic regression with propensity weighting.
In the PLWH cohort, 91.7% were on antiretroviral therapy and 86.1% had HIV viral loads <500 copies/ml. Their mean (± SD) duration of infection was 9.7 ± 4.9 years.
Results indicated that, compared to HIV-negative veterans, PLWH did not differ in LA mechanics and proportion of diastolic dysfunction (p = 0.31). “Using logistic regression with propensity weighting, we found no association between HIV status and degree of diastolic dysfunction,” the authors wrote. “In both cohorts, LA reservoir strain and LA conduit strain were inversely and independently associated with the degree of diastolic dysfunction. Compared with HIV-veterans, PLWH who are primarily viraly suppressed and antiretroviral-treated did not differ in LA strain or LV diastolic dysfunction. If confirmed in other cohorts, HIV viral suppression may curtail adverse alterations in cardiac structure and function.”
- Berg CJ, Patel B, Reynolds M, Tuzovic M, et. al. Left Atrial Mechanics and Diastolic Function Among People Living With Human Immunodeficiency Virus (from the Veterans Aging Cohort Study). Am J Cardiol. 2022 Nov 4;186:50-57. doi: 10.1016/j.amjcard.2022.10.035. Epub ahead of print. PMID: 36343446.