HIV and pericardial fat are associated with abnormal cardiac structure and function among Ugandans

Abstract

Objectives: To examine the relationship between pericardial fat (PCF) and cardiac structure and function among HIV-infected patients in the sub-Saharan African country of Uganda. People living with HIV (PLHIV) have altered fat distribution and an elevated risk for heart failure. Whether altered quantity and radiodensity of fat surrounding the heart relates to cardiac dysfunction in this population is unknown.

Methods: One hundred HIV-positive Ugandans on antiretroviral therapy were compared with 100 age and sex-matched HIV-negative Ugandans; all were >45 years old with >1 cardiovascular disease risk factor. Subjects underwent ECG-gated non-contrast cardiac CT and transthoracic echocardiography with speckle tracking strain imaging. Multivariable linear and logistic regression models were used to explore the association of PCF with echocardiographic outcomes.

Results: Median age was 55% and 62% were female. Compared with uninfected controls, PLHIV had lower body mass index (27 vs 30, p=0.02) and less diabetes (26% vs 45%, p=0.005). Median left ventricular (LV) ejection fraction was 67%. In models adjusted for traditional risk factors, HIV was associated with 10.3 g/m² higher LV mass index (LVMI) (95% CI 3.22 to 17.4; p=0.005), 0.87% worse LV global longitudinal strain (GLS) (95% CI -1.66 to -0.07; p=0.03) and higher odds of diastolic dysfunction (OR 1.96; 95% CI 0.95 to 4.06; p=0.07). In adjusted models, PCF volume was significantly associated with increased LVMI and worse LV GLS, while PCF radiodensity was associated with worse LV GLS (all p<0.05).

Conclusions: In Uganda, HIV infection, PCF volume and density are associated with abnormal cardiac structure and function.

Keywords: HIV; LV GLS; pericardial fat.

Figure 1.. Example of Pericardial Fat with Radiodensity Measurements.

ECG-gated non-contrasted cardiac CT scan with a peri-RCA ROI measuring the mean HU in an axial view at the mid-RCA (large arrow) level (A), and a LA roof fat ROI measuring the mean HU in a coronal view (B). CT = computed tomography; HU = Hounsfield units; LA = left atrium; RCA = right coronary artery; ROI = region of interest

Figure 2.. Conceptual Interaction of HIV, Pericardial Fat, and Cardiac Structure and Function.

Chronic HIV infection contributes to adiposopathy through direct viral effects, ART, and underlying inflammatory process. This includes the development of increased pericardial fat volume with lower radiodensity on CT imaging. These changes in pericardial fat are associated with increased LV mass index and decreased LV GLS, independent of traditional cardiovascular disease risk factors. It remains to be seen whether these changes lead to the development of HFpEF. ART = antiretroviral therapy; CT = computed tomography; GLS = global longitudinal strain; HFpEF = heart failure with preserved ejection fraction; HIV = human immunodeficiency virus; LV = left ventricular