LEFT-VENTRICULAR DIASTOLIC FUNCTION IN ASYMPTOMATIC AND SYMPTOMATIC HUMAN-IMMUNODEFICIENCY-VIRUS CARRIERS - AN ECHOCARDIOGRAPHIC STUDY

Acquired immunodeficiency syndrome (AIDS) is a systemic illness affect ing multiple organs, including the heart. Left ventricular (LV) diasto lic dysfunction has been reported as the first echocardiographically d etectable abnormality in several cardiovascular disorders. We tested t he hypothesis that Human Immunodeficiency Virus (HIV) carriers have LV diastolic impairment wizen studied early in the clinical course of th e infection. Doppler echocardiographic and computerized time-motion pa rameters of LV diastolic function were obtained in 51 HIV patients and in 25 age- and sex-matched healthy controls. The HIV population consi sted of 28 totally asymptomatic subjects and 23 patients with incipien t AIDS. As compared to controls, the HIV group had similar heart rate, blood pressure level, LV dimensions and fractional shortening, but in creased isovolumetric relaxation time (P = 0.03), early filling durati on (P < 0.001) and decreased early mitral flow peak velocity (E) (P = 0.02) and EF slope (P < 0.001). HIV patients also showed lower values for posterior wall thinning (PWT, P < 0.01) and peak lengthening veloc ity of the posterior wall (PVL, P < 0.05), and a trend to a decreased peak rate of LV enlargement in diastole (D+, P = 0.05). Doppler-derive d parameters of diastolic function were significantly altered in the a symptomatic HIV group vs controls. The LV diastolic indices were simil ar in symptomatic and asymptomatic HIV patients except for PWT, which was lower in the symptomatic HIV group (P = 0.04). Since mild and foca l wall motion abormalities were defected in 11 HIV carriers (22%), com parison of LV diastolic indexes between HIV patients and controls was also performed in two subgroups; these included asymptomatic (n = 26) and symptomatic (n = 14) patients with normal contractile state. The t wo subgroups had abnormalities of diastolic function similar to those of the HIV group as a whole, but with somewhat lower levels of statist ical significance Our data strongly suggest that there is myocardial i nvolvement at the early stage of HIV infection; however, its impact on the clinical course of the disease remains to be clarified.