Echocardiographic assessment of pulmonary arterial stiffness in human immunodeficiency virus‐infected patients

Abstract

Background Pulmonary hypertension (PH) is one of the complications of human immunodeficiency virus (HIV) infection. Despite the emergence of effective therapies, pulmonary arterial hypertension is commonly seen, especially at advanced stages. At the time of diagnosis, a majority of patients are at New York Heart Association‐Functional Class III or IV. Many of the current screening modalities are dependent on detecting a rise in pulmonary arterial pressure (PAP). However, high capacitance of the pulmonary circulation implies that early microcirculation loss is not accompanied by a change in resting PAP. Therefore, we aimed to demonstrate early changes in pulmonary vascular disease in HIV‐infected patients with a new echocardiographic parameter, called as pulmonary arterial stiffness (PAS). Methods and Results Thirty‐six HIV‐infected patients and 36 age‐ and sex‐matched healthy control subjects were enrolled in this study. PAS was calculated echocardiographically by using maximal frequency shift and acceleration time of the pulmonary artery flow trace. There was no significant difference in diastolic functions, right ventricular diameters, systolic PAP, inferior vena cava widths, right atrial area, and tricuspid annular plane systolic excursion values between the two groups. However, PAS was calculated as 24.3 ± 6.4 Hz/msn in HIV‐infected patients and 19.3 ± 3.1 Hz/msn in healthy control group (P < 0.001). Increase in PAS was correlated with duration of HIV infection (P < 0.05). Conclusion Our results suggest that HIV infection affects pulmonary vascular bed starting early onset of disease and this can be demonstrated by an easy‐to‐measure echocardiographic parameter.

Assessment of pulmonary arterial stiffness in patients with cirrhosis: A prospective cohort study

“…In addition, an independent and significant relationship between PAS and RV dysfunction has been demonstrated 21 . Previously, PAS was shown to be a significant determinant in the occurrence of PAH in subjects with chronic lung disease, 10 as well as an early prognosticator of RV dysfunction in patients with systemic lupus erythematosus and HIV 9,12 . However, to our knowledge, no prior research has examined the PAS in cirrhotic patients.…”

“…Moreover, PAS can represent early changes in the pulmonary vascular region in congenital cardiac disease cases without significant PAH 8 . In the current literature, several studies show that PAS is linked with RV (right ventricular) dysfunction, PAH, and disease severity in subjects with structural cardiac disease, HIV (human immunodeficiency virus), and chronic lung disease 8–12 . However, to our knowledge, no prior research has evaluated PAS in cirrhotic patients.…”

Assessment of Pulmonary Arterial Stiffness in Patients with Cirrhosis: A Prospective Cohort Study

“…In addition, an independent and significant relationship between PAS and RV dysfunction has been demonstrated (21). Previously, PAS was shown to be an significant determinant in the occurrence of PAH in subjects with chronic lung disease (10), as well as an early prognosticator of RV dysfunction in patients with systemic lupus erythematosus and HIV (9,12). However, to our knowledge, no prior research has examined the PAS in cirrhotic patients.…”

“…Moreover, PAS can represent early changes in the pulmonary vascular region in congenital cardiac disease cases without significant PAH (8). In the current literature, several studies show that PAS is linked with RV (right ventricular) dysfunction, PAH, and disease severity in subjects with structural cardiac disease, HIV (human immunodeficiency virus), and chronic lung disease (8)(9)(10)(11)(12). However, to our knowledge, no prior research has evaluated PAS in cirrhotic patients.…”

Screening strategies for pulmonary arterial hypertension

“…Patients considered for liver transplantation should be screened for PH by echocardiography followed by RHC if needed, as the presence of PAH is associated with significant mortality risk after transplantation 1 , 2 . Research is ongoing to improve PAH screening in these at risk-populations, and this includes studies on the utility of a new echocardiographic parameter, pulmonary arterial stiffness, and in HIV 72 and CHD populations 73 . Further research is needed to guide screening in at-risk populations, particularly trials of screening algorithms for PAH as currently, there is only a body of evidence for PAH-SSc, which we focus on here.…”