Left Atrial Mechanics and Diastolic Function Among People Living With Human Immunodeficiency Virus (from the Veterans Aging Cohort Study).
Left Atrial Mechanics and Diastolic Function Among People Living With Human Immunodeficiency Virus (from the Veterans Aging Cohort Study).
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人类免疫缺陷病毒感染者的左心房力学和舒张功能（来自退伍军人衰老队列研究）。
DOI：
10.1016/j.amjcard.2022.10.035
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
So-Armah
中科院分区：
文献类型：
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作者：
Berg,ChristopherJ;Patel,Bobby;Reynolds,Maxwell;Tuzovic,Mirela;Chew,KaraW;Sico,JasonJ;Bhattacharya,Debika;Butt,AdeelA;Lim,JosephK;Bedimo,RogerJ;Brown,SheldonT;Gottdiener,JohnS;Warner,AlbertaL;Freiberg,MatthewS;So-Armah
人类免疫缺陷病毒（HIV）感染与亚临床心肌病、舒张功能障碍和心血管死亡风险增加有关。然而，左心房（LA）力学和左心室（LV）舒张功能之间的关系尚未在艾滋病毒感染者（PLWH）相对于艾滋病毒未感染者（HIV−）对照进行评估。这是一项多中心、横断面队列分析，使用退伍军人老龄化队列研究数据库的HIV心血管疾病子研究，旨在检查一组没有已知心血管疾病的PLWH和HIV-退伍军人。共确定了277例受试者（180例PLWH，97例HIV−）的超声心动图。计算左心室和左心房相位应变，并评价舒张功能。采用方差分析和倾向加权有序Logistic回归分析评估左心房应变、左心室应变和舒张功能障碍程度之间的关系。在艾滋病毒携带者队列中，91.7%接受抗逆转录病毒治疗，86.1%的艾滋病毒载量<500拷贝/ml。平均（± SD）感染持续时间为9.7 ± 4.9年。相对于HIV-退伍军人，PLWH在LA力学和舒张功能障碍比例方面没有差异（p = 0.31）。使用逻辑回归与倾向加权，我们没有发现艾滋病毒状态和舒张功能障碍的程度之间的关联。在两个队列中，左心房储层应变和左心房导管应变与舒张功能障碍的程度呈负相关且独立相关。与HIV-退伍军人相比，主要接受病毒抑制和抗逆转录病毒治疗的PLWH在LA应变或LV舒张功能障碍方面没有差异。如果在其他队列中得到证实，HIV病毒抑制可能会减少心脏结构和功能的不良改变。
Human immunodeficiency virus (HIV) infection is associated with subclinical cardiomyopathy, diastolic dysfunction, and increased risk of cardiovascular death. However, the relationship between left atrial (LA) mechanics and left ventricular (LV) diastolic function has not been evaluated in people living with HIV (PLWH) relative to HIV-uninfected (HIV−) controls. This is a multicenter, cross-sectional cohort analysis using the HIV Cardiovascular Disease substudy of the Veterans Aging Cohort Study database, which aimed to examine a cohort of PLWH and HIV− veterans without known cardiovascular disease. A total of 277 subjects (180 PLWH, 97 HIV−) with echocardiograms were identified. LV and LA phasic strain were derived and diastolic function was evaluated. Relationship between LA strain, LV strain, and the degree of diastolic dysfunction were assessed using analysis of variance and ordinal logistic regression with propensity weighting. In the PLWH cohort, 91.7% were on antiretroviral therapy and 86.1% had HIV viral loads <500 copies/ml. The mean (± SD) duration of infection was 9.7 ± 4.9 years. Relative to HIV− veterans, PLWH did not differ in LA mechanics and proportion of diastolic dysfunction (p = 0.31). Using logistic regression with propensity weighting, we found no association between HIV status and degree of diastolic dysfunction. In both cohorts, LA reservoir strain and LA conduit strain were inversely and independently associated with the degree of diastolic dysfunction. Compared with HIV− veterans, PLWH who are primarily virally suppressed and antiretroviral-treated did not differ in LA strain or LV diastolic dysfunction. If confirmed in other cohorts, HIV viral suppression may curtail adverse alterations in cardiac structure and function.