Cardiac dysfunction and mortality in HIV-infected children - The prospective (PCHIV)-C-2-H-2 multicenter study

Background-Left ventricular (LV) dysfunction is common in children infected with the human immunodeficiency virus (HIV), but its clinical importance i s unclear. Our objective was to determine whether abnormalities of LV struc ture and function independently predict all-cause mortality in HIV-infected children. Methods and Results-Baseline echocardiograms were obtained on 193 children with vertically transmitted HIV infection (median age, 2.1 years). Children were followed up for a median of 5 years. Cox regression was used to ident ify measures of LV structure and function predictive of mortality after adj ustment for other important demographic and baseline clinical risk factors. The time course of cardiac variables before mortality was also examined. T he 5-year cumulative survival was 64%. Mortality was higher in children who , at baseline, had depressed LV fractional shortening (FS) or contractility ; increased LV dimension, thickness, mass, or wall stress; or increased hea rt rate or brood pressure (P less than or equal to 0.02 for each). Decrease d LV FS (P<0.001) and increased wall thickness (P=0.004) were also predicti ve of increased mortality after adjustment for CD4 count (P<0.001), clinica l center (P<0.001), and encephalopathy (P<0.001). FS showed abnormalities f or up to 3 years before death, whereas wall thickness identified a populati on at risk only 18 to 24 months before death. Conclusions-Depressed LV FS and increased wall thickness are risk factors f or mortality in HIV-infected children independent of depressed CD4 cell cou nt and neurological disease. FS may be useful as a long-term predictor and wall thickness as a short-term predictor of mortality.