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J Card Fail. 2018 Apr;24(4):255-265. doi: 10.1016/j.cardfail.2018.02.001. Epub 2018 Mar 2.

Diastolic Dysfunction in Individuals With Human Immunodeficiency Virus Infection: Literature Review, Rationale and Design of the Characterizing Heart Function on Antiretroviral Therapy (CHART) Study.

Author information

1
Cardiology Division, Department of Medicine, Stony Brook University, Stony Brook, New York. Electronic address: Javed.butler@stonybrookmedicine.edu.
2
Cardiology Division, Department of Medicine, Stony Brook University, Stony Brook, New York.
3
Duke Clinical Research Institute, Duke University, Durham, North Carolina.
4
Cardiology Division, Department of Medicine, University of California, San Francisco, California.
5
Cardiology Division, Department of Medicine, Duke University, Durham, North Carolina.
6
UCSF Department of Medicine and San Francisco Department of Veterans Administration, San Francisco, California.
7
Cardiology Division, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois.
8
Duke Clinical Research Institute, Duke University, Durham, North Carolina; Cardiology Division, Department of Medicine, Duke University, Durham, North Carolina.
9
Division of Cardiovascular Sciences, National, Heart, Lung, and Blood Institute, Bethesda, Maryland.
10
Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Abstract

Antiretroviral therapy (ART) has been associated with a shift in the epidemiology of human immunodeficiency virus (HIV)-associated cardiomyopathy from a phenotype of primarily left ventricular (LV) systolic dysfunction to LV diastolic dysfunction (DD). Patients with HIV receiving ART have higher rates of DD compared with age-matched control subjects and develop DD at a younger age. However, little is known about the natural history and pathogenesis of DD in virally suppressed HIV-infected patients. Current evidence suggests that immune processes modulate the risk for cardiac involvement in HIV-infected persons. Ongoing inflammation appears to have myocardial effects, and accelerated myocardial fibrosis appears to be a key mediator of HIV-induced DD. The Characterizing Heart Function on Antiretroviral Therapy (CHART) study aims to systematically investigate determinants, mechanisms, and consequences of DD in HIV-infected patients. We will compare ART-treated virally suppressed HIV-infected individuals with and without DD and HIV- individuals with DD regarding (1) systemic inflammation, myocardial stress, and subclinical myocardial necrosis as indicated by circulating biomarkers; (2) immune system activation as indicated by cell surface receptors; (3) myocardial fibrosis according to cardiac magnetic resonance examination; (4) markers of fibrosis and remodeling, oxidative stress, and hypercoagulability; (5) left atrial function according to echocardiographic examination; (6) myocardial stress and subclinical necrosis as indicated by circulating biomarkers; (7) proteomic and metabolic profiles; and (8) phenotype signatures derived from clinical, biomarker, and imaging data.

KEYWORDS:

Human immunodeficiency virus; diastolic dysfunction; heart failure; pathophysiology

PMID:
29482027
PMCID:
PMC5880702
DOI:
10.1016/j.cardfail.2018.02.001
[Indexed for MEDLINE]
Free PMC Article

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