ABC | Volume 113, Nº4, October 2019

Original Article The Use of Two-Dimensional Strain Measured by Speckle Tracking in the Identification of Incipient Ventricular Dysfunction in HIV-Infected Patients on Antiretroviral Therapy, Untreated HIV Patients and Healthy Controls Ronaldo Campos Rodrigues, Katia Martins Lopes de Azevedo, Samuel Datum Moscavitch, Sergio Setubal, Claudio Tinoco Mesquita Universidade Federal Fluminense (UFF), Niterói, RJ – Brazil Mailing Address: Ronaldo Campos Rodrigues • Rua Tenente Ronaldo Santoro, 208, Apt. 101.Postal Code: 23080-270, Campo Grande, RJ – Brazil. E-mail: contato@cursodeecocardiografia.com Manuscript received February 04, 2018, revised manuscript March 07, 2019, accepted March 12, 2019. DOI: 10.5935/abc.20190169 Abstract Background: Most cardiovascular abnormalities in patients infected with the human immunodeficiency virus (HIV) have been associated with myocardial damage directly caused by the virus. Some cases, however, may be associated with adverse effects from antiretroviral therapy (ART). New ventricular function assessment techniques are capable of detecting early changes in the cardiac function of HIV-infected patients using or not using ART. The usefulness of these techniques has been little employed in these patients. Objectives: To investigate the potential influence of antiretroviral therapy (ART) on the occurrence of subclinical left ventricular systolic dysfunction evaluated by myocardial strain rate analysis using two-dimensional speckle tracking echocardiography (2-D Echo) in treated HIV patients compared to untreated patients and healthy individuals. Methods: Sixty-eight HIV-infected patients with no cardiovascular symptoms, normal left ventricular (LV) ejection fraction (>0.55 on 2-D Echo) were divided into three groups: 11 patients not using antiretroviral therapy (NT), 24 using protease inhibitor (PI) and 33 using non-nucleoside reverse transcriptase inhibitor (NNRTI). We also studied 30 normal non-HIV infected individuals (Ctrl). Demographic, clinical, biochemical and anthropometric data were collected. Preliminary transthoracic echocardiography included study of myocardial strain using two-dimensional speckle tracking. We studied strain and strain rate in the seventeen left ventricular (LV) myocardial segments in the longitudinal, circumferential and radial axes. Statistical analysis of the data was done with IBM SPSS – version 20 for Windows. Upon analysis of the data, namely the normality of independent variables in the different groups and the homogeneity of the variances between the groups, Kruskal-Wallis’ non‑parametric test was done, followed by Dunn’s multiple comparison tests to test the significance of the differences between the values measured in the study groups. A significance level of 5% was adopted for decision-making on statistical tests. Results: The mean age of HIV patients was 40 ±  8.65 years and the mean age of controls was 50 ±  11.6 years (p < 0.001). Median LV global longitudinal strain (GLS) of NT patients (–17.70%), PI patients (–18.27%) and NNRTIs (–18.47%) were significantly lower than that of the Ctrl group (–20.77%; p = 0.001). There was no significant difference in mean SLG between treated patients (PI, NNRTI) and untreated (NT) patients. No significant differences were observed in mean circumferential and radial strain, nor on circumferential and radial strain rates between the NT, PI, NNRTI and Ctrl groups. Conclusion: The data suggest that HIV patients present, on myocardial strain measured by speckle tracking, signs of early LV systolic dysfunction that seem to be unrelated to the presence of ART. The prognostic significance of this condition in these patients deserves further studies. (Arq Bras Cardiol. 2019; 113(4):737-745) Keywords: Acquired Immunodeficiency Syndrome; HIV; Ventricular Disfunction,Left; Echocardiography, Doppler; Antiretroviral Therapy; Highly Active; Strain; Speckle Tracking. Introduction Around the world, deaths related to the acquired immunodeficiency syndrome (AIDS) declined from about 1.9 million in 2005 to about 1 million in 2016, largely due to expansion of treatment – for the first time, more than half of people infected with the human immunodeficiency virus (HIV) were under treatment for the disease. Since 2010, the annual number of new infections in all age groups decreased by 16%. However, progress is variable and, despite a global downward trend in this epidemic disease, several regions have been experiencing a sharp increase in the number of new infections and difficulties in expanding treatment.¹ The antiretroviral therapy (ART) was an important development for HIV-infected patients, contributing to prolonged survival and improved quality of life.² Cardiovascular diseases have become a common finding because of the longer survival of these patients. Another important aspect of cardiovascular complications is that they appear to be associatedwith the effects of ART. 3, 4 Although a decline in the incidence of severe heart 737