HIV

Diastolic Dysfunction Alters Cardiac Structure, Function in Patients With HIV Receiving ART

Diastolic dysfunction is associated with alterations in cardiac structure and function, as well as reduced quality of life, in individuals with HIV who are receiving antiretroviral therapy, according to results of the Characterization of Heart Function on Antiretroviral Therapy (CHART) study.

To reach this conclusion, the researchers enrolled 195 treated and virally suppressed patients with HIV in the multi-center CHART study. All of the participants had normal ejection fraction (more than 50%), and none of the participants had significant valvular disease or history of coronary revascularization or persistent atrial fibrillation. 

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In all, 94 participants had diastolic dysfunction and 101 did not. Gender, race, CD4 count, and HIV ribonucleic acid copies were similar between the groups. Those who had diastolic dysfunction were older; had a higher body mass index; and were more likely to have hypertension, renal dysfunction, and dyslipidemia.

The researchers determined that those with diastolic dysfunction had higher levels of NT-pro-B-type natriuretic peptide l and high-sensitivity troponin I. And while all the participants had similar left atrial size, those with diastolic dysfunction had increased stiffness vs those without diastolic dysfunction (conduit strain: 30.0 vs 23.5); they also had more impaired relaxation (reservoir strain: 45.9 vs 39.7).

Participants with diastolic dysfunction also had higher prevalence of focal fibrosis than those without dysfunction (19.0% vs 5.3%).

Compared with participants without diastolic dysfunction, those with the dysfunction also had:

  • Higher levels of carboxyl-terminal telopeptide of collagen type I
  • Trends toward higher interlukin-6 and oxidized low-density lipoprotein levels
  • Lower Kansas City Cardiomyopathy Questionnaire scores
  • Lower symptom frequency scores

“In this contemporary HIV+ population receiving antiretroviral therapy, [diastolic dysfunction] was associated with multiple alterations in cardiac structure and function, including myocardial fibrosis and left atrial abnormalities, and worse quality of life,” the researchers concluded. “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.”

—Colleen Murphy

Reference:

Butler J, Greene SJ, Shah SH, et al. Diastolic dysfunction in patients with human immunodeficiency virus receiving antiretroviral therapy: results from the CHART Study [published online November 1, 2019]. J Card Fail. https://doi.org/10.1016/j.cardfail.2019.10.011.