CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 8, September 2012
AFRICA
e3
Of the 100 cases studied, 99 had cardiac chamber dimension
measurements taken. One did not because a large pericardial
effusion precluded accurate measurements. Comparison of
the echocardiographic dimensions between the cases and the
controls is summarised in Table 2.
HIV-positive patients had significantly increased LVEDs,
ERV and LVMI compared with the controls. Although the
LVEDd was higher in the cases, it did not reach the level
of statistical significance. However left ventricular dilatation,
defined as LVEDd
>
5.2
cm, was significantly more in the cases
than the controls (
p
=
0.03).
Comparison of left ventricular systolic and diastolic functions
is summarised in Table 3. The cases had significantly reduced
systolic parameters (LVFS, LVEF) and significantly increased
IVRT, an important diastolic parameter, compared with the
controls.
Echocardiographic abnormalities were found in 78% of the
cases overall compared with 16% in the controls (
χ
2
=
52.38;
p
=
0.000).
The echocardiographic abnormalities are summarised
in Table 4.
Of the 100 cases studied, 30 (30%) had systolic dysfunction
compared with four of the 50 controls (8%),
p
=
0.004.
Twenty-
five (83%) of these had mild dysfunction, while five (17%) had
moderate to severe dysfunction. Of the 25 patients who had
mild systolic dysfunction, 17 (68%) had a CD
4
count less than
200/
µ
l, while eight (32%) had a CD
4
>
200/
µ
l. All five (17%)
with moderate to severe systolic dysfunction had a CD
4
count
<
200/
µ
l. There was no regional wall-motion abnormality in the
cases.
Furthermore, 32 (32%) of the cases had diastolic dysfunction
compared with four of the controls (8%),
p
=
0.002.
Of
these, six (19%) had impaired relaxation; 10 (31%) had
pseudonormalisation pattern, while the remaining 16 (50%)
had restrictive diastolic dysfunction. Of the cases that had either
pseudonormalisation or restrictive diastolic dysfunction, 15
(58%)
had CD
4
counts
<
200/
µ
l, while the remaining 11 (42%)
had CD
4
>
200/
µ
l.
Five (5%) of the cases and none of the controls had dilated
cardiomyopathy (
p
=
0.169),
while one of the cases had isolated
right-sided dilatation. One of the cases also had aortic root
dilatation with severe regurgitation, while another had mitral
valve prolapse.
Pericardial involvement was common in the cases. Of the
100
cases, 47 (47%) had pericardial effusion, while none had
this in the control group (Table 4). This difference was strikingly
significant (
p
=
0.000).
In patients with pericardial effusion, 39
had mild effusion while eight had moderate to severe effusion,
with a mean CD
4
cell count of 125/
µ
l (Fig. 1).
All five patients with dilated cardiomyopathy (DCM) had a
CD
4
count
<
200/
µ
l. The mean CD
4
of those with DCM was 80/
µ
l. The only patient with isolated right-sided dilatation had a CD
4
count of 67/
µ
l.
Discussion
This study clearly reveals that the majority of patients with
HIV infection had echocardiographic abnormalities which were
clinically quiescent. This suggests echocardiography as a relevant
tool for diagnosis of sub-clinical cardiac abnormalities, with the
aim of instituting management early where necessary. Similar
findings have been reported by other workers.
9,24,25
Our study shows that pericardial effusion was frequently
seen in our HIV-infected patients, with a spectrum ranging
from asymptomatic mild effusion to severe pericardial
TABLE 2. ECHOCARDIOGRAPHIC DIMENSIONS
IN CASESAND CONTROLS
Parameters
Cases
(
n
=
99)
Controls
(
n
=
50)
t
p
LA (cm)
2.94
±
0.51 2.96
±
0.39 0.201 0.841
AO (cm)
2.71
±
0.45 2.60
±
0.38 0.999 0.319
RVOT (cm)
2.85
±
0.41 2.95
±
0.49 1.316 0.190
ERV (cm)
2.11
±
0.43 1.91
±
0.30 2.937 0.004*
IVS (cm)
0.97
±
0.19 0.93
±
0.17 1.414 0.160
LVPW (cm)
0.83
±
0.15 0.84
±
0.17 0.155 0.877
LVEDd (cm)
4.58
±
0.58 4.50
±
0.53 0.816 0.416
LVEDs (cm)
3.23
±
0.54 2.99
±
0.46 2.712 0.008*
LVEDd/BSA (cm/m
2
) 2.77
±
0.35 2.69
±
0.29 1.412 0.160
LVMI (g/m
2
)
84.33
±
24.68 78.72
±
23.81 42.87 0.000*
RWT
0.37
±
0.08 0.38
±
0.08 0.151 0.881
Values are mean ± SD. LA: left atrial diameter; AO: aortic root diameter;
AOEX: aortic excursion; RVOT: right ventricular outflow tract; ERV: esti-
mated right ventricular diameter; IVS: interventricular septum; LVPW:
posterior wall thickness; LVEDd: left ventricular end-diastolic diameter;
LVEDs: left ventricular end-systolic diameter; BSA: body surface area.
*
p
<
0.05
is statistically significant.
TABLE 3. SYSTOLICAND DIASTOLIC
PARAMETERS IN CASESAND CONTROLS
Parameters
Cases
(
n
=
99)
Controls
(
n
=
50)
t
p
SV
63.91
±
24.90 66.19
±
22.92 0.54 0.589
LVEF
64.45
±
8.63 70.17
±
7.08 4.05 0.000*
LVFS
29.60
±
5.60 34.51
±
14.61 2.95 0.004*
DT (ms)
187.82
±
30.45 181.04
±
16.23 1.48 0.142
IVRT(s)
88.24
±
19.62 80.81
±
10.81 2.48 0.015*
E
75.05
±
16.77 77.71
±
16.59 0.92 0.36
A
50.20
±
11.25 51.51
±
11.29 0.67 0.50
E/A
1.56
±
0.49 1.55
±
0.33 0.02 0.89
EPSS
0.45
±
0.31 0.34
±
0.22 2.11 0.04*
Values are mean ± SD. SV: stroke volume; LVEF: Left ventricular ejec-
tion fraction; LVFS: left ventricular fractional shortening; DT: decelera-
tion time; IVRT: isovolumic relaxation time. E: early diastolic filling;
A: atrial contraction; E/A: ratio of early (E) to late (A) diastolic filling
velocities in the mitral inflow; EPSS: endpoint septal separation.
*
p
<
0.05
is statistically significant.
TABLE 4. ECHOCARDIOGRAPHICABNORMALITIES
IN CASESAND CONTROLS
Echocardiographic
abnormalities
Cases
(
n
=
99)
Controls
(
n
=
50)
χ
2
p
Pericardial effusion*
47 (47.00)
0 (0)
32.10 0.000
Systolic dysfunction
30 (30.30)
4 (8)
8.16 0.004
Diastolic dysfunction
32 (32.32)
4 (8)
9.44 0.002
Dilated left ventricle
15 (15.15)
1 (2)
4.70 0.031
Dilated cardiomyopathy
5 (5.05)
0 (0)
1.29 0.169
Isolated right-sided dilatation 1 (1.01)
0 (0)
0.12 1.000
Aortic root dilatation
1 (1.01)
0 (0)
0.12 1.000
Mitral valve prolapse
1 (1.01)
0 (0)
0.12 1.000
Values are number (%). *
n
=
100
cases for pericardial effusion.
