Echocardiographic patterns in treatment-naïve HIV-positive patients in Lagos, south-west Nigeria

Abstract

Introduction: Cardiovascular abnormalities are common in HIV-infected patients, although often clinically quiescent. This study sought to identify by echocardiography early abnormalities in treatment-naïve patients.

Methods: One hundred patients and 50 controls with no known traditional risk factors for cardiovascular disease were recruited for the study. The cases and controls were matched for age, gender and body mass index. Both groups had clinical and echocardiographic evaluation for cardiac abnormalities, and CD4 count was measured in all patients.

Results: The cases comprised 57 females (57.0%) and 43 males (43.0%), while the controls were 28 females (56.0%) and 22 males (44.0%) (χ(2) = 0.01; p = 0.913). The mean age of the cases was 33.2 ± 7.7, while that of the controls was 31.7 ± 9.7 (t = 1.02; p = 0.31). Echocardiographic abnormalities were significantly more common in the cases than the controls (78 vs 16%; p = 0.000), including systolic dysfunction (30 vs 8%; p = 0.024) and diastolic dysfunction (32 vs 8%; p = 0.002). Other abnormalities noted in the cases were pericardial effusion in 47% (χ(2) = 32.10; p = 0.000) and dilated cardiomyopathy in 5% (five); none of the controls had either complication. One patient each had aortic root dilatation, mitral valve prolapse and isolated right heart dilatation and dysfunction.

Conclusion: Cardiac abnormalities are more common in HIV-infected people than in normal controls. A careful initial and periodic cardiac evaluation to detect early involvement of the heart in the HIV disease is recommended.

Fig. 1.

Massive pericardial effusion in a patient with HIV/AIDS, shown from the pasternal long-axis view.

Fig. 2.

Apical four-chamber view showing dilated cardiomyopathy.

Fig. 3.

Apical four-chamber view showing isolated right ventricular and atrial dilatation. Note the significantly enlarged right ventricle and right atrium, compared with the small left ventricle and left atrium.

Fig. 4.

Apical five-chamber view of one of the patients with a dilated aortic root, showing moderate to severe aortic regurgitation. Note the red flame from the middle (aortic ring) extending towards the apex of the left ventricle.