Myocardial and microvascular inflammation/infection in patients with HIV-associated pulmonary artery hypertension.
AIDS
; 28(17): 2541-9, 2014 Nov 13.
Article
em En
| MEDLINE
| ID: mdl-25144217
ABSTRACT
BACKGROUND:
Right ventricle compromise affects survival of patients with HIV-associated pulmonary artery hypertension (PAH).DESIGN:
Myocardial histology with viral assessment may clarify the mechanism of right ventricular deterioration and provide clues on PAH origin.METHODS:
Fifteen patients with HIV infection, PAH and right ventricular dysfunction underwent cardiac magnetic resonance, catheterization, coronary with ventricular angiography and biventricular endomyocardial biopsy. Endothelial expression of HLA-DR, ICAM-1, E-selectin and VCAM-1 was semi-quantitatively evaluated. PCR for HIV, hepatitis C virus, human herpes virus-6, human herpes virus-8, Epstein-Barr virus, adenovirus, cytomegalovirus, enterovirus, influenza A/B and parvovirus B19 was performed. In PCR-positive hearts, viral protein adenovirus-1 and TORDJI-22 were assessed by immunohistology.RESULTS:
New York Heart Association class was 2.4â±â0.5, mean pulmonary artery pressure 49.93â±â10.15âmmHg and wedge pressure 9.5â±â2.19âmmHg. Coronaries were normal with slow flow. Left ventricular and/or right ventricular micro-aneurysms were seen in eight patients. Cardiac magnetic resonance documented increased right ventricular end-diastolic volume with reduced ejection fraction, normal left ventricular end-diastolic volume and left ventricular ejection fraction. Subepicardial/mesocardial oedema and delayed enhancement in the inter-ventricular junction and/or left ventricular inferolateral wall was detected in eight patients. Histology showed active lymphocytic myocarditis in 12 patients, with microvasculitis in three. Endothelial adhesion molecules were over-expressed in all patients. PCR was positive in four patients for hepatitis C virus and in two for adenovirus, and viruses localized both in cardiomyocytes and endothelial cells.CONCLUSIONS:
Inflammation/infection of myocardium and intramural vessels is detectable in patients with HIV-associated PAH. It may adversely affect right ventricular function and have a role in the compromised pulmonary circulation.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Vasculite
/
Vírus
/
Infecções por HIV
/
Coinfecção
/
Hipertensão Pulmonar
/
Miocardite
Tipo de estudo:
Risk_factors_studies
Limite:
Adult
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Ano de publicação:
2014
Tipo de documento:
Article