Multimodality Imaging in HIV-Associated Cardiovascular Complications: A Comprehensive Review
Abstract
:1. Introduction
2. HIV-Associated Cardiovascular Complications
2.1. Myocarditis
2.2. HIV Associated Cardiomyopathy
2.3. Pericardial Diseases
2.4. Coronary Artery Diseases
2.5. Pulmonary Hypertension
2.6. Cardiac Neoplasm
2.7. Vasculitis
2.8. Endocarditis
3. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Cardiovascular Manifestation | Authors | Type of Study | Number of Patients | Imaging Modality | Imaging Findings |
---|---|---|---|---|---|
Myocarditis | Luetkens, J.A. et al. | Prospective cohort study | 28 patients and 22 control subjects | CMR | Compared with healthy controls, HIV-infected patients showed lower ejection fraction, lower global strain values, elevated native T1 and T2 values, and myocardial fibrosis, predominantly at the subepicardial of the midventricular and basal inferolateral wall. |
Ntusi, N. et al. | Cross sectional observational study | 103 patients and 92 control subjects | CMR | Compared with controls, HIV-infected patients had lower LVEF, higher myocardial mass, lower peak diastolic strain rate, and higher native T1 values. Pericardial effusions and myocardial fibrosis were 3 and 4 times more common, respectively, in subjects with HIV infection. | |
Robbertse et al. | Prospective study | 73 patients and 22 healthy controls | CMR | Compared with controls, a significant decrease in native T1 and ECV was seen after 9 months of HAART in HIV patients, which was significantly associated with a decrease in C-reactive protein, a decrease in HIV viral load, and an improvement in CH4 count. | |
De Leuw et al. | Prospective observational study | 156 patients | CMR | Patients with higher ECV values have a higher rate of cardiovascular outcomes. | |
Ca rdiomyopathy | Sliwa, K. et al. | Prospective, registry study | 518 HIV infected patients | CMR | The most common primary diagnosis attributable to HIV/AIDS was HIV-related cardiomyopathy (38%), followed by pericarditis/pericardial effusion (25%), HIV-related pulmonary hypertension (8.1%), and coronary artery diseases (2.4%). |
Simon et al. | Prospective multicentre study | 104 HIV infected patients | TTE | Pulmonary hypertension (PAP>35 mm Hg) was seen in 15% patients, but RV dysfunction (RV fractional area change FAC < 35%) occurred in 11%. The study highlighted that RV dysfunction in HIV-infected individuals may be a separate entity from LV/global cardiomyopathy or pulmonary hypertension. | |
de Leuw, P. et al. | Prospective observational longitudinal study | 156 HIV infected patients | CMR | Patients with higher native T1, native T2, and LV mass indexes have higher events. In multivariable analyses, native T1 was independently predictive of adverse events. Traditional cardiovascular risk scores were not predictive of adverse events. | |
Pericardial diseases | Himelman, R.B. et al. | Prospective observational study | 70 HIV infected patients | TTE | Pericardial effusion seen in 10% patients. |
Akhras, F. et al. | Prospective observational study | 124 patients (101 with AIDS and 23 without opportunistic infection) | TTE | Pericardial effusion was more common in patients with AIDS (44%) as compared to HIV infected patients without opportunistic infections (9%). | |
Coronary artery disease | Raggi, P. et al. | Prospective observational study | 843 patients | CT | In a median follow-up of 2.8 years, it was seen that a CAC score of 100 was associated with 3.3-times higher odds of myocardial infarction, independent of gender and age. |
Zanni, M.V. et al. | Cross sectional study | 101 patients and 41 controls | CTA | The study showed an increased prevalence of low-attenuation coronary plaque in HIV-positive men compared to age-matched HIV-negative healthy controls. | |
Hoffmann, U. et al. | Cohort study | 755 HIV infected patients | CTA | Atherosclerotic plaque was seen in 49% patients. Luminal obstruction of at least 50% was rare (3%), but vulnerable plaque were more frequently observed (23%). Overall, 35% of patients demonstrated coronary artery calcium score scores greater than 0. IL-6. LpPLA2, oxLDL, and MCP-1 levels were higher in those with plaque compared to those without. | |
Irene, J. et al. | Cross sectional study | 27 HIV infected patients | MR angiography | More than half of the subjects showed CAD with luminal narrowing detected on MR angiography. There was no association between CAD and previous cardiac conditions (viral pericarditis and zidovudine related cardiomyopathy). | |
Pulmonary hypertension | Mehta et al. | Analytic review | 131 HIV infected patients | TTE | The most common imaging finding was right heart chamber enlargement (98%), followed by tricuspid regurgitation (64%), and paradoxical septal motion (40%). |
Cardiac Lymphoma | Goldfarb et al. | Case report | 1 | TTE, CT and CMR | CMR showed extensively filtrating mass lesion compressing the atria and main pulmonary artery and extending into the atrioventricular grooves and ventricular walls. There was contiguous involvement of the adjacent subcarinal mediastinum and superior vena cava as well. |
Shinro et al. | Case report | 1 | TTE, CT and CMR | CMR showed large well-demarcated mass in the right atrium extending to the superior vena cava. The mass showed poor enhancement with an iso-intense appearance to the myocardium on MRI. | |
Llitjos et al. | Case report | 1 | CMR | CMR showed an infiltrating mass involving the right ventricular free and inferior walls and the interventricular septum. The lesion was seen encasing the entire right coronary artery. | |
Vasculitis | Gouny et al. | Case series | 3 | CTA | First case: a saccular aneurysm of the aorta whose neck was situated 3 cm proximal to the renal arteries and associated with a left lateral aortic hematoma; Second case: a fusiform aneurysm with a retroaortic extravasation suggesting chronic rupture and thickening of the anterior aspect of the aneurysmal wall; Third case: a fusiform aneurysm of the aorta extending to the common iliac arteries with its neck located 3 cm distal from the renal arteries. |
Sellami et al. | Case report | 1 | CTA | Early CT finding consisted of a slight-enhancing periaortic soft-tissue, while the aorta remained of normal size. Within two weeks, infection progressed to an infected aneurysm. | |
Endocarditis | Valencia et al. | Retrospective study | 42 | TTE | The tricuspid valve was the most commonly affected valve (83%), followed by the mitral valve (9.7%), the aortic valve (2.4%), and the pulmonary valve (7.3%). |
Bosch et al. | 1 | 1 | TTTE | TTE showed vegetation in the medial and apical portions of the septum with normal mitral or aortic valves. |
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Kumar, P.; Arendt, C.; Martin, S.; Al Soufi, S.; DeLeuw, P.; Nagel, E.; Puntmann, V.O. Multimodality Imaging in HIV-Associated Cardiovascular Complications: A Comprehensive Review. Int. J. Environ. Res. Public Health 2023, 20, 2201. https://doi.org/10.3390/ijerph20032201
Kumar P, Arendt C, Martin S, Al Soufi S, DeLeuw P, Nagel E, Puntmann VO. Multimodality Imaging in HIV-Associated Cardiovascular Complications: A Comprehensive Review. International Journal of Environmental Research and Public Health. 2023; 20(3):2201. https://doi.org/10.3390/ijerph20032201
Chicago/Turabian StyleKumar, Parveen, Christophe Arendt, Simon Martin, Safaa Al Soufi, Philipp DeLeuw, Eike Nagel, and Valentina O. Puntmann. 2023. "Multimodality Imaging in HIV-Associated Cardiovascular Complications: A Comprehensive Review" International Journal of Environmental Research and Public Health 20, no. 3: 2201. https://doi.org/10.3390/ijerph20032201