Seventy adults who tested positive for human immunodeficiency virus (HIV) were prospectively studied with serial echocardiography to better define the prevalence and progression of cardiac disease in such patients. Fifty outpatients (Group A), including 44 with acquired immunodeficiency syndrome (AIDS) and 6 with AIDS-related complex, and 20 additional patients (Group B) with asymptomatic HIV infection had baseline echocardiography studies at a time when no patient had symptomatic heart disease. Follow-up studies were performed at 9 ± 3 months in 52 patients (74%) and again at 15 ± 3 months after baseline studies in 29 patients (41%). During the study, 22 patients (44%) in Group A and 1 patient (5%) in Group B died.
Cardiac abnormalities were noted in 26 patients (52%) in Group A and 8 patients (40%) in Group B (p = NS) on initial or follow-up study. An abnormal left ventricular ejection fraction (<45%) or fractional shortening (<28%) was seen in seven patients in Group A; of these, three had normal left ventricular function on a later echocardiogram. One patient in Group B had persistent left ventricular dysfunction. All patients in Group A with left ventricular dysfunction on two serial studies died within 1 year after the initial echocardiogram. Ejection fraction did not change between baseline and two follow-up studies in either group (A: 52 ± 9 vs. 56 ± 9 vs. 55 ± 5%, p = NS; B: 58 ± 6 vs. 58 ± 5 vs. 59 ± 6%, p = NS). Right-sided cardiac enlargement resolved in 18 patients (44%), including 5 of 10 in Group A and 3 of 8 in Group B. Pericardial effusions resolved without specific intervention in 5 (42%) of 12 patients in Group A and 2 (50%) of 4 in Group B. Analysis of CD4 counts revealed no relation with the presence of left ventricular dysfunction or right-sided cardiac enlargement. In patients with AIDS with pericardial effusion, however, CD4 counts were significantly lower (68 ± 74/mm3) than in those without effusion (290 ± 248/mm3, p < 0.001).
Thus, echocardiography abnormalities are common in asymptomatic outpatients with HIV infection, and persistent left ventricular dysfunction portends an especially grim prognosis in patients with AIDS. Some of these abnormalities, including left ventricular dysfunction, right-sided cardiac enlargement and pericardial effusion, are transient in nature and are not consistently associated with clinically apparent intercurrent illnesses. These findings have important implications for future studies involving therapy for AIDS-associated heart disease.
