Speckle tracking echocardiographic assessment of patterns and distribution of ventricular strain impairment in young adults with human immunodeficiency virus infection

Background. The aim of the study was to assess biventricular parameters of wall deformation with three-dimensional speckle tracking echocardiography (3DSTE) in patients with human immunodeficiency virus infection (HIV) on antiretroviral therapy in order to detect a possible subclinical myocardial dysfunction. A second aim was to compare these changes with the 3DSTE findings in patients with idiopathic non-ischemic dilated cardiomyopathy and systo-diastolic dysfunction to better understand the magnitude and distribution pattern of ventricular strain impairment in HIV-infected patients Methods. Twenty patients aged 17 to 35years with HIV acquired early in life, 20 normal controls of the same age and sex, and 15 patients with idiopathic non-ischemic dilated cardiomyopathy (DCM) were studied with 3DSTE. All HIV patients were stable in terms of HIV infection, with no history of heart disease or other chronic systemic disease except HIV infection. Patients were on HAART with good immunological control. Standard echocardiographic measures of LV-RV function were assessed. LV global longitudinal strain (GLS), circumferential and radial strains were calculated. Global area strain (GAS) was calculated by 3DSTE as percentage variation in surface area defined by the longitudinal and circumferential strain vectors. Right ventricular (RV) 3D global and free-wall longitudinal strain were obtained. Results. LV GLS and GAS were lower in HIV patients compared to normal controls (p=0.016, and p=0.003, respectively). There were no significant differences in LV ejection fractions between the groups. There was a weak positive correlation between LV GLS and age (r=0.453, p=0.032) and a weak negative correlation between LV GLS and CD4 T-cells count (r=0.312, p=0.041). DCM patients had more marked and widespread reduction in LV GLS compared to controls (p<0.0001), whereas in HIV patients LV LS impairment (p<0.01) was more localized in basal and apical regions. RV free-wall longitudinal strain was significantly reduced in HIV patients when compared with the control group (p=0.027). No patient had pulmonary systolic pressure higher than 35mmHg. Conclusions. Three-dimensional speckle tracking echocardiography may help to identify HIV patients at high cardiovascular risk allowing early detection of biventricular dysfunction in the presence of normal LV ejection fraction and in the absence of pulmonary hypertension. LV strain impairment in HIV patients is less prominent and widespread compared to DCM patients.