AUTHOR=Liao Chia-Te , Toh Han Siong , Chang Wei-Ting , Yang Chun-Ting , Chen Zhih-Cherng , Tang Hung-Jen , Strong Carol 

TITLE=Assessment of subclinical cardiac dysfunction by speckle-tracking echocardiography among people living with human immunodeficiency virus

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1200418

DOI=10.3389/fcvm.2023.1200418

ISSN=2297-055X

ABSTRACT=Background 
People living with HIV (PLWH) have an increased risk of developing cardiovascular diseases (CVD). As speckle tracking echocardiography (STE) has been used to detect subclinical myocardial abnormalities, this study aims to detect early cardiac impairment among Asian PLWH using STE, and to investigate the associated risk factors.

Methods
We consecutively recruited asymptomatic PLWH without previous CVD from a medical center of Taiwan, and cardiac function was evaluated by conventional and STE. Enrolled PLWH were classified as anti-retroviral therapy (ART)-experienced and ART-naive, and multivariable regressions were used to assess the association between myocardial strain and risk factors including traditional CVD and HIV-associated factors. 

Results
A total of 181 PLWH (mean age:36.4±11.4 years, 173 males) are recruited and conventional echocardiogram parameters were within normal ranges. Decreased myocardial strain across myocardium was found, with a mean left ventricular (LV) global longitudinal strain of -18.7±2.9%. The LV strain in ART-experienced group (-19.0±2.9%) was significantly better than ART-naive group (-17.9±2.8%), despite a younger age and lesser CVD risk factors in the ART-naive group. Hypertension [B=1.92, 95% confidence interval (95%CI) 0.19-3.62, p=0.029)]and ART-naive with both low and high viral loads (VL) (B=1.09, 95%CI 0.03-2.16, p=0.047 and B=2.00, 95%CI,0.22-3.79, p=0.029) were significantly associated with reduced myocardial strain.

Conclusion
This is the first and largest cohort using STE to investigate myocardial strain in Asian PLWH. Our results suggest that hypertension and detectable VL are associated with impaired myocardial strain. Thus, timely ART administration with VL suppression and hypertension control are crucial in preventing CVD when making the management parallel with the improved life expectancy of PLWH on ART.