CMR-based Assessment Of Myocardial Injury In Asymptomatic People Living With Human Immunodeficiency Virus

Objective:To evaluate the presence of subclinical myocardial injury in asymptomatic Human Immunodeficiency Virus(HIV)-infected patients by cardiac magnetic resonance(CMR)imaging and to explore the possible association between subclinical myocardial injury and HIV-related clinical characteristics.Methods:80 asymptomatic HIV-infected people(age[median,interquartile range]:53years[47-56years];90%male)and 50 healthy participants(age:52 years[36-58 years];78%male)matched with HIV-infected people according to age and sex were included in this study.The CMR protocol at 3 tesla included cine imaging,native T1,T2,and T2*mapping of the left ventricular.The associations between CMR parameters and HIV-related clinical characteristics,including white cell counts,were evaluated by Spearman rank correlation and logistic regression.Results:The left ventricular ejection fraction in asymptomatic HIV-infected participants was lower than that in healthy control subjects(60.6±3.4%vs.62.6±3.0%,p=0.001),but was still within normal range.HIV-infected participants revealed significantly higher native myocardial T1 values(1241±29ms vs.1189±21ms,p<0.001),native T2 values(40.7±1.5ms vs.37.9±1.4ms,p<0.001),but showed no difference in native T2*values(17.3ms[16.3-19.1ms]vs.18.3ms[16.5-19.3ms],p=0.201).Spearman correlation analysis showed that the native T1 increment in HIV-infected participants with subclinical myocardial injury a negative correlation was found with the nadir CD4+T-cell count(R=-0.316,p=0.023).In multivariable analyses,after adjusting for the confounding factor of Framingham risk score(10-year risk),the incidence of subclinical myocardial injury in HIV-infected participants with the nadir CD4+T cell count less than 500 cell/mm~3 was6.12 times higher than that in HIV-infected participants with the nadir CD4+T cell count greater than 500 cell/mm~3.(odds ratio,6.12[95%confidence interval,1.07-34.91]p=0.041)Conclusions:Subclinical myocardial inflammation is present in asymptomatic HIV-infected patients.A lower nadir CD4 count is a risk factor for subclinical myocardial injury,which may serve as a biomarker for determining subclinical myocardial injury in HIV-infected patients.