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Cardiac dysfunction in pauci symptomatic human immunodeficiency virus patients: a meta-analysis in the highly active antiretroviral therapy era.

Abstract

AIMS

Human immunodeficiency virus infection (HIV) has been associated with cardiac dysfunction that, if present, can negatively affect morbidity and mortality of HIV-infected patients. Unfortunately, many of the studies on this topic were performed before the highly active antiretroviral therapy (HAART) was established. Thus, we performed a comprehensive meta-analysis to critically appraise the incidence of cardiac dysfunction in HIV-infected pauci symptomatic patients.

METHODS AND RESULTS

Medline, Cochrane Library, and Biomed Central were systematically screened for studies reporting on systolic and/or diastolic dysfunctions in HIV pauci-symptomatic patients. Baseline treatment and cardiac imaging data were appraised and pooled with random effect methods computing summary. At pooled analysis, including a total of 2242 patients from 11 studies, an overall average incidence of traditional cardiovascular risk factors was observed, while a low rate of previous coronary artery disease was reported. Incidence of systolic and diastolic left ventricular dysfunction was 8.33% (95% CI: 2.20-14.25) and 43.38% (95% CI: 31.73-55.03), respectively. Diastolic dysfunction was graded as first [31.85% (95% CI: 24.85-43.73)], second [8.53% (95% CI: 2.12-14.93)], and third degree [3.02% (95% CI: 1.78-4.27)]. At multivariate analysis, a high sensitivity C-reactive protein level >5 mg/L, active tobacco smoking and previous history of myocardial infarction were predictors of left ventricular systolic dysfunction [odd ratio 1.70 (95% CI: 1.03-2.77); 1.57 (95% CI: 1.03-2.34); and 15.90 (95% CI: 1.94-329.00), respectively]. Hypertension (OR = 2.30; 95% CI: 1.20-4.50) and older age (OR = 2.50 per 10 years increase; 95% CI: 1.70-3.60) were predictors of left ventricular diastolic dysfunction (Figure  3).

CONCLUSIONS

Systolic and diastolic dysfunction represent a common finding in pauci symptomatic HIV-infected patients, regardless to HAART.

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  • Authors+Show Affiliations

    ,

    Division of Cardiology, Azienda Ospedaliera Cittá della Salute e della Scienza, Corso Bramante 88-90, 10126 Turin, Italy. enrico.cerrato@gmail.com

    , , , , , , , , , , , , ,

    Source

    European heart journal 34:19 2013 May pg 1432-6

    MeSH

    Adult
    Antiretroviral Therapy, Highly Active
    HIV Infections
    Heart Diseases
    Humans
    Middle Aged
    Stroke Volume
    Tomography, Emission-Computed, Single-Photon

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review

    Language

    eng

    PubMed ID

    23335603

    Citation

    Cerrato, Enrico, et al. "Cardiac Dysfunction in Pauci Symptomatic Human Immunodeficiency Virus Patients: a Meta-analysis in the Highly Active Antiretroviral Therapy Era." European Heart Journal, vol. 34, no. 19, 2013, pp. 1432-6.
    Cerrato E, D'Ascenzo F, Biondi-Zoccai G, et al. Cardiac dysfunction in pauci symptomatic human immunodeficiency virus patients: a meta-analysis in the highly active antiretroviral therapy era. Eur Heart J. 2013;34(19):1432-6.
    Cerrato, E., D'Ascenzo, F., Biondi-Zoccai, G., Calcagno, A., Frea, S., Grosso Marra, W., ... Gaita, F. (2013). Cardiac dysfunction in pauci symptomatic human immunodeficiency virus patients: a meta-analysis in the highly active antiretroviral therapy era. European Heart Journal, 34(19), pp. 1432-6. doi:10.1093/eurheartj/ehs471.
    Cerrato E, et al. Cardiac Dysfunction in Pauci Symptomatic Human Immunodeficiency Virus Patients: a Meta-analysis in the Highly Active Antiretroviral Therapy Era. Eur Heart J. 2013;34(19):1432-6. PubMed PMID: 23335603.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Cardiac dysfunction in pauci symptomatic human immunodeficiency virus patients: a meta-analysis in the highly active antiretroviral therapy era. AU - Cerrato,Enrico, AU - D'Ascenzo,Fabrizio, AU - Biondi-Zoccai,Giuseppe, AU - Calcagno,Andrea, AU - Frea,Simone, AU - Grosso Marra,Walter, AU - Castagno,Davide, AU - Omedè,Pierluigi, AU - Quadri,Giorgio, AU - Sciuto,Filippo, AU - Presutti,Davide, AU - Frati,Giacomo, AU - Bonora,Stefano, AU - Moretti,Claudio, AU - Gaita,Fiorenzo, Y1 - 2013/01/18/ PY - 2013/1/22/entrez PY - 2013/1/22/pubmed PY - 2014/1/8/medline KW - Antiretroviral therapy KW - Echocardiography KW - HAART KW - HIV KW - Heart failure SP - 1432 EP - 6 JF - European heart journal JO - Eur. Heart J. VL - 34 IS - 19 N2 - AIMS: Human immunodeficiency virus infection (HIV) has been associated with cardiac dysfunction that, if present, can negatively affect morbidity and mortality of HIV-infected patients. Unfortunately, many of the studies on this topic were performed before the highly active antiretroviral therapy (HAART) was established. Thus, we performed a comprehensive meta-analysis to critically appraise the incidence of cardiac dysfunction in HIV-infected pauci symptomatic patients. METHODS AND RESULTS: Medline, Cochrane Library, and Biomed Central were systematically screened for studies reporting on systolic and/or diastolic dysfunctions in HIV pauci-symptomatic patients. Baseline treatment and cardiac imaging data were appraised and pooled with random effect methods computing summary. At pooled analysis, including a total of 2242 patients from 11 studies, an overall average incidence of traditional cardiovascular risk factors was observed, while a low rate of previous coronary artery disease was reported. Incidence of systolic and diastolic left ventricular dysfunction was 8.33% (95% CI: 2.20-14.25) and 43.38% (95% CI: 31.73-55.03), respectively. Diastolic dysfunction was graded as first [31.85% (95% CI: 24.85-43.73)], second [8.53% (95% CI: 2.12-14.93)], and third degree [3.02% (95% CI: 1.78-4.27)]. At multivariate analysis, a high sensitivity C-reactive protein level >5 mg/L, active tobacco smoking and previous history of myocardial infarction were predictors of left ventricular systolic dysfunction [odd ratio 1.70 (95% CI: 1.03-2.77); 1.57 (95% CI: 1.03-2.34); and 15.90 (95% CI: 1.94-329.00), respectively]. Hypertension (OR = 2.30; 95% CI: 1.20-4.50) and older age (OR = 2.50 per 10 years increase; 95% CI: 1.70-3.60) were predictors of left ventricular diastolic dysfunction (Figure  3). CONCLUSIONS: Systolic and diastolic dysfunction represent a common finding in pauci symptomatic HIV-infected patients, regardless to HAART. SN - 1522-9645 UR - https://www.unboundmedicine.com/medline/citation/23335603/full_citation L2 - https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehs471 DB - PRIME DP - Unbound Medicine ER -