Global Longitudinal Strain and Immune Status in Patients Living With Human Immunodeficiency Virus

Abstract

Improvement in survival in patients living with human immunodeficiency virus (PLHIV) has led to increased prevalence of cardiovascular disease. Whether HIV-associated immune dysfunction is associated with preclinical left ventricular (LV) dysfunction despite normal LV ejection fraction (LVEF) is unclear. Accordingly, we investigated the relation of immune status and LV function in PLHIV. Global longitudinal strain (GLS) analyses were performed retrospectively on all echocardiograms for PLHIV who had available HIV-1 RNA viral load, nadir, and proximal CD4 cell count data at Duke University Medical Center between 2001 and 2012. The relation between HIV-1 RNA viral load, nadir, and proximal CD4 count and GLS as a continuous dependent variable was assessed with unadjusted and adjusted linear regression. GLS was calculated for 253 PLHIV. Median GLS in our cohort was - 15.1% with interquartile range from (-16.7 to -13.6). All participants had an LVEF ≥50%. In adjusted analyses, proximal CD4 <500 cells/mm³ and nadir CD4 <250 cells/mm³ were significantly inversely correlated with GLS (p = 0.01 and p = 0.004, respectively). In PLHIV, patient with plasma HIV RNA <400 copies/ml at baseline had a trend toward significantly more negative values of GLS compared with those patients without viral suppression at baseline (p = 0.08). In conclusion, this study is the first to demonstrate such a high prevalence of abnormal GLS in PLHIV, and the first to identify that proximal and nadir CD4 cell count are independently associated with GLS despite normal LVEF.

Figure 1.

Flow chart for extracting Duke HIV unique cohort (n = 253). Abbreviations: CD4 = cluster of differentiation 4; DELD = Duke Echocardiography Laboratory Database; DHIVCD Duke HIV Clinical Database; HIV = human immunodeficiency virus; PLHIV patients living with HIV; STE = speckle tracking echocardiography; TTE = transthoracic echocardiography.

Figure 2.

Boxplot of mean GLS for viral load (plasma HIV RNA) (<400 vs ≥400). Abbreviations: GLS = global longitudinal strain; HIV = human immunodeficiency virus; RNA = ribonucleic acid.