Evolution of myocardial oedema and fibrosis in HIV infected persons after the initiation of antiretroviral therapy: a prospective cardiovascular magnetic resonance study.
Evolution of myocardial oedema and fibrosis in HIV infected persons after the initiation of antiretroviral therapy: a prospective cardiovascular magnetic resonance study.
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DOI：
10.1186/s12968-022-00901-0
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发表时间：
2022-12-19
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人类免疫缺陷病毒(HIV)感染者在接受抗逆转录病毒治疗(ART)时，已被证明有功能和结构上的改变，并可能与心血管炎症有关。越来越多的证据表明，HIV感染者的心肌在开始抗逆转录病毒治疗前可能是异常的，可能是亚临床的HIV相关性心肌病(HIVAC)。ART对亚临床HIVAC的影响尚不清楚。新诊断的、幼稚的艾滋病毒感染者与未感染艾滋病毒的、年龄和性别匹配的对照组一起登记。所有参与者都接受了全面的心血管评估，包括在1.5T CMR成像系统上对比心血管磁共振(CMR)和多参数标测。HIV组开始接受抗逆转录病毒治疗(替诺福韦/拉米夫定/多洛替格韦)，并在9个月后进行前瞻性评估。分别对横断面数据和配对的前瞻性数据进行适当的统计检验，比较组内和组间的心脏组织特征。纳入73例单纯艾滋病病毒感染者(32例 ± 7岁，女性占45%)和22例健康非艾滋病患者(33例 ± 7岁，女性占50%)。与非HIV感染者相比，确诊时HIV感染者的整体固有T1(1008 ± 31 ms vs 1032 ± 44 ms，p = 0.02)、整体T2(46 ± 2 vs 48 ± 3 ms，p = 0.006)和心包积液发生率(18%vs 67%，p <； 0.001)显著升高。在接受抗逆转录病毒治疗9个月后，全球天然T1(1032 ± 44至10 14 ± 34 ms，p <； 0.001)和细胞外体积(ECV)(26 ± 4%至25 ± 3%，p = 0.001)显著下降，并与艾滋病毒病毒载量的减少、高敏C反应蛋白的降低以及CD 4计数的改善(p <； 0.001)显著相关。艾滋病病毒感染组的更替纤维化发生率显著高于对照组(49%比10%，p = 0.02)。在9个月的研究期间，晚期Gd增强的发生率没有显著变化(49%比55%，p = 0.4)。亚临床HIVAC可能在HIV诊断时已经存在，正如在应用ART之前发现的亚临床心肌水肿和纤维化的组合所提示的那样。在短期内，ART改善了心肌水肿的组织特征标记物，然而，尚不清楚潜在的病理机制是被ART阻止了，还是仅仅是被ART减缓了。需要进行中长期前瞻性研究，以评估随时间推移的微小心肌变化和亚临床心肌纤维化的意义。
Human immunodeficiency virus (HIV) infected persons on antiretroviral therapy (ART) have been shown to have functionally and structurally altered ventricles and may be related to cardiovascular inflammation. Mounting evidence suggests that the myocardium of HIV infected individuals may be abnormal before ART is initiated and may represent subclinical HIV-associated cardiomyopathy (HIVAC). The influence of ART on subclinical HIVAC is not known. Newly diagnosed, ART naïve persons with HIV infection were enrolled along with HIV uninfected, age- and sex-matched controls. All participants underwent comprehensive cardiovascular assessment, including contrasted cardiovascular magnetic resonance (CMR) with multiparametric mapping on a 1.5T CMR system. The HIV group was started on ART (tenofovir/lamivudine/dolutegravir) and prospectively evaluated 9 months later. Cardiac tissue characterisation was compared in, and between groups using the appropriate statistical tests for the cross sectional data and the paired, prospective data respectively. Seventy-three ART naïve HIV infected individuals (32 ± 7 years, 45% female) and 22 healthy non-HIV subjects (33 ± 7 years, 50% female) were enrolled. Compared with non-HIV healthy subjects, the global native T1 (1008 ± 31 ms vs 1032 ± 44 ms, p = 0.02), global T2 (46 ± 2 vs 48 ± 3 ms, p = 0.006), and the prevalence of pericardial effusion (18% vs 67%, p < 0.001) were significantly higher in the HIV infected group at diagnosis. Global native T1 (1032 ± 44 to 1014 ± 34 ms, p < 0.001) and extracellular volume (ECV) (26 ± 4% to 25 ± 3%, p = 0.001) decreased significantly after 9 months on ART and were significantly associated with a decrease in the HIV viral load, decreased high sensitivity C-reactive protein, and improvement in the CD4 count (p < 0.001). Replacement fibrosis was significantly higher in the HIV infected group than controls (49% vs 10%, p = 0.02). The prevalence of late gadolinium enhancement did not change significantly over the 9-month study period (49% vs 55%, p = 0.4). Subclinical HIVAC may already be present at the time of HIV diagnosis, as suggested by the combination of subclinical myocardial oedema and fibrosis found to be present before administration of ART. Markers of myocardial oedema on tissue characterization improved on ART in the short term, however, it is unclear if the underlying pathological mechanism is halted, or merely slowed by ART. Mid- to long term prospective studies are needed to evaluate subtle myocardial changes over time and to assess the significance of subclinical myocardial fibrosis.
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影响因子：
2.1
作者：
Robbertse, Pieter-Paul S.;Doubell, Anton F.;Steyn, Jan;Lombard, Carl J.;Talle, Mohammed A.;Herbst, Philip G.
通讯作者：
Herbst, Philip G.
DOI：
10.1186/1532-429x-13-13
发表时间：
2011-02-18
期刊：
Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance
影响因子：
--
作者：
Eitel I;Friedrich MG
通讯作者：
Friedrich MG
DOI：
10.1186/s12968-017-0389-8
发表时间：
2017-10-09
期刊：
Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance
影响因子：
--
作者：
Messroghli DR;Moon JC;Ferreira VM;Grosse-Wortmann L;He T;Kellman P;Mascherbauer J;Nezafat R;Salerno M;Schelbert EB;Taylor AJ;Thompson R;Ugander M;van Heeswijk RB;Friedrich MG
通讯作者：
Friedrich MG
DOI：
10.1186/s12968-016-0308-4
发表时间：
2016-11-30
期刊：
Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance
影响因子：
--
作者：
Haaf P;Garg P;Messroghli DR;Broadbent DA;Greenwood JP;Plein S
通讯作者：
Plein S
影响因子：
--
作者：
Carbone I;Childs H;Aljizeeri A;Merchant N;Friedrich MG
通讯作者：
Friedrich MG