MRI Assessment of Diastolic Dysfunction in People Living With the Human Immunodeficiency Virus: Correlation With Markers of Disease Activity

Background Despite the advent of combination antiretroviral therapy, people living with human immunodeficiency virus (PLWH) are at an increased risk for cardiac disease. Purpose To explore the presence and extent of diastolic atrial and left ventricular dysfunction in PLWH using cardiac MRI in correlation with clinical markers of disease activity. Study Type Prospective. Population A total of 163 participants comprising 101 HIV‐infected individuals (age: 52 years [42–62 years]; 92% male) and 62 age‐ and sex‐matched healthy volunteers (age: 51 years [30–72 years]; 85% male). Field Strength/Sequence 3.0 T, cardiac MRI including balanced steady‐state free precession ( SSFP ) for the short‐axis, two‐, three‐, and four‐chamber views were performed. Assessment Assessment of cardiac function and strain analysis were accomplished by CVI42 software. Blood samples for CD4 + T cells and cardiac risk factors were also collected before MRI. Statistical Tests Independent t tests, Mann–Whitney U test, Pearson's correlation analysis, and multivariate linear analyses (significance level: P < 0.05). Results PLWH had a significantly larger left atrial volume maximum index (LAVImax: 32.6 ± 8.7 vs. 28.7 ± 8.1 mL/m 2 ), minimum (LAVImin: 14.8 ± 5.5 vs. 11.5 ± 5.4 mL/m 2 ,), and prior to atrial contraction (LAVIpre‐a: 23.4 ± 6.7 vs. 19.7 ± 7.2 mL/m 2 ) as compared to healthy volunteers. The LA reservoir (LAtEF: 55.0 ± 10.2 vs. 61.4 ± 10.4; Sls: 29.0 ± 8.1 vs. 33.8 ± 11.8), conduit (LApEF: 28.4 ± 8.2 vs. 32.3 ± 11.3, P = 0.01; Sle: 16.3 ± 6.5 vs. 18.9 ± 8.2), and booster pump function (LAaEF: 37.4 ± 12.4 vs. 42.7 ± 13.1, P = 0.01, Sla: 12.7 ± 5.1 vs. 14.9 ± 5.7) were all significant impaired in PLWH. Global circumferential left ventricular diastolic strain rate (LVGCS‐d) was significantly lower in the HIV patients. Multivariate analysis results showed that Nadir CD4 + T cells had a significant adverse association with LVGCS‐d ( β = 0.51). Conclusion LA structure abnormalities and LV diastolic dysfunction were manifested in PLWH, with Nadir CD4+ T cell counts potentially serving as a risk factor for early cardiac diastolic dysfunction. Level of Evidence 2 Technical Efficacy Stage 3