Left ventricular (LV) dysfunction is known to be present in HIV infected subjects. The prevalences of other risk factors for cardiomyopathy including hypertension, diabetes, coronary disease, obesity, and alcohol use are also high in this patient population in the United States, but are quite low in HIV infected Africans. This study sought to determine the prevalence of LV systolic and diastolic function in HIV infected Rwandans.
In Rwanda, 41 unselected patients (age 36+/-9 years, 10% male) without known cardiac disease underwent echocardiography. No patient had been treated with anti-retroviral therapy. LV mass and ejection fractions (EF) were calculated according to the American Society of Echocardiography standards. Diastolic dysfunction was studied with pulsed Doppler echocardiography. For each echo variable, 3-5 cardiac cycles were averaged. Significant LV systolic function dysfunction was predefined as <50%. Diastolic dysfunction was defined as E/A ratio<1.0 or >1 with either a prolonged deceleration time (>250msecs) or a prolonged isovolumic relaxation time (>120msecs). Clinical data were recorded.
There were low prevalences of cardiovascular risk factors including: hypertension 2.4%, diabetes 2.4%, smoking 0%. LV systolic dysfunction was present in 2.4% of patients and diastolic dysfunction was present in 14.6%. LV dysfunction was unrelated to age or duration of infection.
In conclusion, LV dysfunction is common in HIV infected Rwandans, and is predominantly diastolic rather than systolic. LV dysfunction was less common than prior reports from the United States possibly because of a lower prevalence of cardiomyopathy risk factors.
Further study of additional patients is warranted in order to substantiate these initial findings. There may be an interaction between HIV and other risk factors for LV dysfunction.
Jason Lazar, None.