In people with HIV, left ventricular dysfunction and intermediate pulmonary hypertension probability were associated with decreased exertional capacity (>30m) and worse quality of life (>4 units).
Cohort (n=186)
Are echocardiographic markers of cardiac and pulmonary vascular dysfunction associated with worse patient-reported outcomes and mortality in people with HIV?
In well-controlled people with HIV, echocardiographic markers of cardiac and pulmonary vascular dysfunction are associated with worse exertional capacity, quality of life, and survival.
Abstract Rationale HIV is associated with increased risk for cardiac, pulmonary, and pulmonary vascular disease and worse cardiopulmonary patient-reported outcomes (PROs). Whether cardiac and pulmonary vascular abnormalities contribute to PROs in people with HIV (PWH) is unknown. We aimed to assess associations between echocardiographic markers of cardiac and pulmonary vascular dysfunction and PROs in PWH. Methods We included 186 PWH from the Pittsburgh HIV Lung Cohort with concurrent transthoracic echocardiography, pulmonary function, and PRO assessment from 2012-2019. Primary exposures were: left ventricular (LV) systolic dysfunction (LVSD; defined as LV ejection fraction≤50%), LV diastolic dysfunction (LVDD), and pulmonary hypertension probability (PH; defined using tricuspid regurgitant velocity TRV criteria as low TRV≤2.8 m/s, intermediate TRV 2.9-3.4 m/s, and high TRV3.4 m/s). Outcomes were: exertional capacity (assessed by six-minute walking distance), symptom burden, quality of life (assessed by St. George’s Respiratory Questionnaire), and all-cause mortality. Given the exposed groups’ small sample size and concerns for model overfitting, we performed separate multivariable linear, logistic, median, and Cox proportional hazards regression analyses adjusting for demographics (age, sex, race), clinical covariates (body-mass index, smoking, anemia), HIV markers (years with HIV, CD4 T-cell count, detectable viremia), and pulmonary function (post-bronchodilator forced expiratory volume in 1 sec/forced vital capacitylower limit of normal LLN, diffusing capacity of the lung for carbon monoxideLLN). Results Participant median age was 54.9 years, 77.4% were men, and 69.7% were ever smokers. Time living with HIV was 20.7 years, median CD4 count was 626 cells/mL, and 83.3% had undetectable viral load. Prevalence rates of LVSD, LVDD, and intermediate and high PH probability were 5.4%, 33.9%, 13.2%, and 2.6%, respectively. Twenty-nine deaths occurred over median 8.5-years. In all models, LVSD, LVDD, and intermediate PH probability were associated with decreased exertional capacity and worse quality of life (Table 1). Effect sizes exceeded the minimally clinically important differences of 30 meters and 4 units, respectively. LVSD and intermediate PH probability were associated with increased dyspnea prevalence in models adjusting for demographics, clinical covariates, and HIV markers, but not in the pulmonary function-adjusted model. Only LVSD was associated with increased risk for death. Conclusions Among well-controlled PWH, markers of cardiac and pulmonary vascular dysfunction were associated with worse PROs, even after adjusting for pulmonary impairment. These findings suggest the potential utility of active case-finding with echocardiography for early identification and treatment of cardiac and pulmonary vascular abnormalities to improve exertional capacity, symptoms, and survival in PWH. This abstract is funded by: NHLBI K08HL169023 (IK)
Naghshtabrizi et al. (Fri,) conducted a cohort in HIV (n=186). Left ventricular dysfunction and pulmonary hypertension probability was evaluated on Exertional capacity, symptom burden, quality of life, and all-cause mortality. In people with HIV, left ventricular dysfunction and intermediate pulmonary hypertension probability were associated with decreased exertional capacity (>30m) and worse quality of life (>4 units).