Key result
HIV infection linked to ~1-point worse global longitudinal strain despite preserved ejection fraction.
Why the study?
Conventional echocardiographic measures such as LVEF may remain normal despite early myocardial injury, and the value of GLS to detect subtle myocardial dysfunction in people with HIV was unclear.
Does HIV infection reduce global longitudinal strain compared to HIV-uninfected individuals in adults with preserved left ventricular ejection fraction?
Meta-Analysis (n=749)
Does HIV infection reduce global longitudinal strain compared to HIV-uninfected individuals in adults with preserved left ventricular ejection fraction?
Mean Difference: 0.98 (95% CI 0.15–1.8)
Speckle-tracking echocardiography detects subtle subclinical myocardial impairment via reduced global longitudinal strain in people with HIV, even when conventional left ventricular ejection fraction remains preserved.
Background Conventional echocardiographic measures such as left ventricular ejection fraction (LVEF) may remain normal despite early myocardial injury. Global longitudinal strain (GLS) provides a sensitive measure of myocardial deformation and may detect subtle myocardial dysfunction before changes in LVEF occur. This is particularly relevant in people with HIV (PWH), who face increased cardiovascular risk and myocardial remodeling despite effective antiretroviral therapy. We conducted a systematic review and meta-analysis to evaluate differences in myocardial strain between PWH and HIV-uninfected individuals. Methods We conducted this systematic review and meta-analysis according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched electronic databases (PubMed, Embase, Scopus, and Web of Science) for studies evaluating myocardial strain using speckle-tracking echocardiography (STE) in PWH and HIV-uninfected controls. Comparative studies reporting GLS were included in a random-effects meta-analysis. Results Six studies comprising 749 participants (469 PWH and 280 HIV-uninfected) were included. All studies reported preserved LVEF in both groups. Pooled analysis showed less negative GLS in PWH compared with HIV-uninfected individuals (mean difference 0.98%, 95% CI 0.15–1.80; I² = 77.8%), consistent with mild subclinical myocardial impairment. Sensitivity analyses confirmed the stability of pooled estimates. Three additional studies reporting strain parameters exclusively in PWH supported the presence of early myocardial functional alterations without overt systolic dysfunction. Conclusions PWH demonstrate mild impairment in myocardial deformation despite preserved LVEF, supporting the ability of STE to detect subclinical myocardial dysfunction beyond conventional systolic assessment. While the available evidence is predominantly cross-sectional and should be interpreted as associative rather than causal, these findings highlight the potential value of myocardial strain imaging for earlier cardiovascular evaluation in PWH. Prospective studies, particularly in regions with a high HIV burden, are now needed to determine its prognostic and clinical utility. Trial registration Systematic review registration: PROSPERO CRD420261336120.
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Mutengo et al. (2026) conducted a meta-analysis in HIV infection (n=749). HIV infection vs. HIV-uninfected individuals was evaluated on Global longitudinal strain (GLS) (Mean difference 0.98%, 95% CI 0.15-1.80). People with HIV demonstrated less negative global longitudinal strain compared to HIV-uninfected individuals (mean difference 0.98%), indicating mild subclinical myocardial impairment despite preserved ejection fraction.
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