Human immunodeficiency virus infection and systolic myocardial performance

Cardiac dysfunction in HIV-infected patients is being increasingly recognized. The present echocardiographic and Doppler study was undertaken to evaluate left ventricular (LV) systolic performance during the different stages of the disease. Twenty-nine anti-HIV (positive (+) ambulatory patients (19 with AIDS and 10 with asymptomatic HIV infection) without cardiac symptoms were evaluated by two-dimensional and M-mode echocardiography. Four groups were identified: group A, 10 patients (9 without AIDS) with a normal echocardiogram; group B, 6 patients with LV dilatation but normal LV function; group C, 9 patients with abnormal regional contractility but normal global function; group D, 4 patients with dilated cardiomyopathy (DC). Doppler study of the aortic systolic flow was performed in the four groups and in a normal control group. Doppler parameters—peak aortic velocity, ejection time, and flow velocity integral—were similar in controls and in groups A and B. Groups C and D (with abnormal contractility by echocardiography) had lower values for all Doppler parameters and were significantly different from controls and from groups A and B. Patients with dilated cardiomyopathy (group D) had the lowest values for all Doppler data, consistent with their low systolic performance. This group also had the lowest CD4+ lymphocyte counts and the longest mean probable time of HIV infection (6.5 years), being significantly different from group A patients, who presented a mean probable time of infection of 2.7 years and higher CD4+ counts. The results confirm that myocardial dysfunction affecting HIV-infected patients is more common in the late stages of the disease. It is also shown that Doppler study of the aortic systolic flow relates more closely to global LV performance than conventional echocardiography alone, and better differentiates patients with normal from those with abnormal LV function.