Left ventricular diastolic dysfunction in HIV-uninfected infants exposed in utero to antiretroviral therapy.
Left ventricular diastolic dysfunction in HIV-uninfected infants exposed in utero to antiretroviral therapy.
复制标题
DOI：
10.1097/qad.0000000000002443
复制
发表时间：
2020-03-15
期刊：
影响因子：
--
通讯作者：
Wilkinson JD
中科院分区：
文献类型：
--
作者：
Lipshultz SE;Sasaki N;Thompson B;Eidem BW;Cheng I;Colan SD;O'Brien SE;Amdani S;Shearer WT;Orav EJ;Miller TL;Wilkinson JD
纵向测量围产期接受抗逆转录病毒治疗（ART.）的HIV暴露但未感染（HEU）儿童的LV舒张功能。围产期接受抗逆转录病毒治疗（ART）的HEU儿童可能有心脏不良反应的风险。我们以前曾报道过这些儿童左心室质量、尺寸和室间隔厚度减少，收缩力增加。从出生到48个月的特定时间，从两组未感染艾滋病毒的儿童中获得了一系列超声心动图：148名艾滋病毒阴性儿童围产期暴露于抗逆转录病毒治疗，130名未暴露于抗逆转录病毒治疗的健康对照组。测量左室舒张早期和舒张晚期二尖瓣血流速度（E和A）、组织多普勒左室游离壁和室间隔舒张早期血流速度（LVe'和sep e'）。所有超声心动图指数显着不同的ART暴露的儿童相比，ART未暴露的健康对照。所有年龄组的E和A总体上分别较低8.28 cm/sec（P = 0.0002）和13.46 cm/sec（P < 0.0001）。出生、1岁和2岁时E/A比值分别高0.27、0.46和0.28单位（所有P ≤ 0.01）。此外，所有年龄组的LVe'和sep e'总体上分别较低0.84 cm/sec（P = 0.01）和0.47 cm/sec（P = 0.02）。在子宫内暴露于ART的儿童在特定的LV舒张指数方面具有亚临床但显著的差异。建议对该人群进行系列超声心动图随访，以进一步评估围产期ART暴露的潜在心脏毒性。
To longitudinally measure LV diastolic function in HIV-exposed but uninfected (HEU) children perinatally-exposed to ART. HEU children who were perinatally-exposed to antiretroviral therapy (ART) may be at risk for adverse cardiac effects. We have previously reported that those children have decreased left ventricular (LV) mass, dimension, and septal thickness with increased contractility. Serial echocardiograms were obtained at specific times from birth to 48 months from two groups of HIV-uninfected children: 148 HIV-negative children who were perinatally-exposed to ART and 130 non-ART-exposed HIV-unexposed healthy controls. The following LV diastolic indices were obtained: mitral valve early and late diastolic velocity (E and A), tissue Doppler derived LV free wall and septal early diastolic velocity (LVe’ and sep e’). All echocardiographic indices were significantly different in ART-exposed children compared to ART-unexposed healthy controls. Both E and A were overall lower at all ages by 8.28 cm/sec (P = 0.0002) and 13.46 cm/sec (P < 0.0001) respectively. E/A ratio was higher by 0.27, 0.46, and 0.28 units at birth, 1 year and 2 years of age, respectively (all P ≤ 0.01). Moreover, LVe’ and sep e’ were overall lower at all ages by 0.84 cm/sec (P = 0.01) and 0.47cm/sec (P = 0.02) respectively. Children who were exposed to ART in utero have subclinical yet significant differences in specific LV diastolic indices. Follow-up with serial echocardiograms is recommended in this population to further assess the potential cardiac toxicity of perinatal exposure to ART.