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Original research
HIV and pericardial fat are associated with abnormal cardiac structure and function among Ugandans
  1. Jonathan Buggey1,
  2. Leo Yun2,
  3. Chung-Lieh Hung3,
  4. Cissy Kityo4,
  5. Grace Mirembe4,
  6. Geoffrey Erem5,6,
  7. Tiffany Truong7,
  8. Isaac Ssinabulya6,8,
  9. W H Wilson Tang9,
  10. Brian D Hoit1,7,
  11. Grace A McComsey7,10,11,
  12. Chris T Longenecker1,7
  1. 1 Cardiology, University Hospitals Harrington Heart & Vascular Institute, Cleveland, Ohio, USA
  2. 2 Radiology, Mackay Memorial Hospital, Taipei, Taiwan
  3. 3 Cardiology, Mackay Memorial Hospital, Taipei, Taiwan
  4. 4 Joint Clinical Research Center, Kampala, Uganda
  5. 5 Radiology, Nsambya St Francis Hospital, Kampala, Uganda
  6. 6 Makerere University School of Medicine, Kampala, Uganda
  7. 7 Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
  8. 8 Cardiology, Uganda Heart Institute, Kampala, Uganda
  9. 9 Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
  10. 10 Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio, United States
  11. 11 Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
  1. Correspondence to Dr Chris T Longenecker, Cardiology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA; chris.longenecker{at}


Objectives To examine the relationship between pericardial fat (PCF) and cardiac structure and function among HIV-infected patients in the sub-Saharan African country of Uganda. People living with HIV (PLHIV) have altered fat distribution and an elevated risk for heart failure. Whether altered quantity and radiodensity of fat surrounding the heart relates to cardiac dysfunction in this population is unknown.

Methods One hundred HIV-positive Ugandans on antiretroviral therapy were compared with 100 age and sex-matched HIV-negative Ugandans; all were >45 years old with >1 cardiovascular disease risk factor. Subjects underwent ECG-gated non-contrast cardiac CT and transthoracic echocardiography with speckle tracking strain imaging. Multivariable linear and logistic regression models were used to explore the association of PCF with echocardiographic outcomes.

Results Median age was 55% and 62% were female. Compared with uninfected controls, PLHIV had lower body mass index (27 vs 30, p=0.02) and less diabetes (26% vs 45%, p=0.005). Median left ventricular (LV) ejection fraction was 67%. In models adjusted for traditional risk factors, HIV was associated with 10.3 g/m2 higher LV mass index (LVMI) (95% CI 3.22 to 17.4; p=0.005), 0.87% worse LV global longitudinal strain (GLS) (95% CI −1.66 to −0.07; p=0.03) and higher odds of diastolic dysfunction (OR 1.96; 95% CI 0.95 to 4.06; p=0.07). In adjusted models, PCF volume was significantly associated with increased LVMI and worse LV GLS, while PCF radiodensity was associated with worse LV GLS (all p<0.05).

Conclusions In Uganda, HIV infection, PCF volume and density are associated with abnormal cardiac structure and function.

  • pericardial fat
  • HIV
  • LV GLS

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  • Contributors All listed authors met criteria for authorship.

  • Funding This work was supported in part by the National Institutes of Health (K23 HL123341 to CTL).

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval All study procedures conducted in Uganda were reviewed and approved by the Institutional Review Board of University Hospitals Cleveland Medical Center, the Joint Clinical Research Centre (JCRC; Kampala, Uganda) and the Uganda National Council for Science and Technology.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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