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Prevalence and Patterns of Echocardiographic Abnormalities in HIV-Infected, Black Individuals in an Inner City Teaching Hospital in Washington DC
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Abstract on IDSA website
IDSA Oct 20-23 2011 Boston, MA
Background: Recently accumulating data suggests that patients infected with human immunodeficiency virus (HIV) might be at increased risk for subclinical cardiac abnormalities. We attempted to characterize the structural and functional echocardiographic findings in the HIV infected population encountered in our inner city teaching hospital.
Methods: This was a retrospective, cross-sectional analysis. We analyzed data for 113 consecutively selected HIV positive patients who had an echocardiogram performed between March 2009 and March 2011. These echocardiograms were done in different clinical settings including ambulatory clinics, inpatient wards and critical care units. We observed the prevalence of and conventional cardiac risk factors associated with low left ventricular ejection fraction (LVEF), diastolic dysfunction (DD), left ventricular hypertrophy (LVH), right ventricular systolic pressure (RVSP) and left atrial enlargement (LAE). RVSP was used as a surrogate marker for pulmonary arterial pressure (PAP).
Results:
Data from 113 patients was analyzed and patient characteristics were as follows: mean age 47.50 years, 53.1% females, 100% black, 56.6% on highly active anti-retroviral therapy (HAART) and median CD4+ T-cell count 129 μ/ml.
Overall 23% patients had low LVEF (<55%),
8.9% had DD,
25.7% had LAE,
37.2% had increased LV wall thickness,
59.3% had elevated PAP and
12.4% had pericardial effusion.
Factors significantly associated (P<0.05) with low LVEF were history of CAD, prior heart failure, dyslipidemia and chronic kidney disease (CKD); for DD, body mass index (BMI) >30; for LAE, BMI >30 and diabetes mellitus. There was no significant difference in cardiac abnormalities in patients on HAART versus those not on HAART.
Conclusion: The prevalence of structural and functional cardiac abnormalities was noted to be high. Modifiable cardiac risk factors were significantly associated (P<0.05) with these findings. CD4+ T-cell count, viral load and individual HAART regimen were not noted to contribute significantly to echocardiographic abnormalities. As HIV-infected patients are living longer in the era of HAART, our findings reinforce the need for aggressive management of modifiable cardiac risk factors.
Samad Rasul, MBBS/MD1, Shweta Ramsahai, MD2, Rajesh Chintala, MD3, Faria Farhat, MD4, Hemant Boolani, MD3 and San Thaw Dar Aye, MD5, (1)Div. of Infectious Diseases, Dept. of Internal Medicine, Howard University Hospital, Washington, DC, (2)Infectious Diseases, Howard University Hospital, Washington, DC, (3)Howard University Hospital, Washington, DC, (4)Infectious Disease, Howard University Hospital, Washington, DC, (5)Howard University Hospital, Washington , DC
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