ABC | Volume 113, Nº4, October 2019

Original Article Rodrigues et al. Myocardial strain measured by speckle tracking Arq Bras Cardiol. 2019; 113(4):737-745 Table 2 – Echocardiographic variables Variable NT (n = 11) PI (n = 24) NNRTI (n = 33) Control (n = 30) Kruskal-Wallis test (p) Aorta (mm) M ± SD 28.27 ± 1.85 30.58 ± 3.02 28.73 ± 2.97 29.53 ± 2.08 0.026 Md ± IQR 29.00 ± 3.00 30.00 ± 3.50 29.00 ± 4.00 30.00 ± 2.00 LA diameter (mm) M ± SD 31.18 ± 3.82 33.21 ± 3.22 31.64 ± 4.59 34.33 ± 2.55 0.004 Md ± IQR 30.00 ± 6.00 32.00 ± 4.50 31.00 ± 3.00 34.00 ± 4.00 LVDd-i (mm/m 2 ) M ± SD 29.75 ± 0.79 29.75 ± 1.81 28.67 ± 2.36 28.20 ± 1.73 0.020 Md ± IQR 29.70 ± 1.13 29.87 ± 2.75 29.73 ± 4.22 28.65 ± 2.84 LVSD (mm) M ± SD 30.36 ± 2.38 31.17 ± 4.04 32.18 ± 3.26 32.17 ± 2.78 0.248 Md ± IQR 30.00 ± 5.00 31.00 ± 7.00 32.00 ± 4.00 31.50 ± 4.00 IVS (mm) M ± SD 7.18 ± 0.98 7.88 ± 1.08 7.91 ± 0.95 9.03 ± 0.76 < 0.001 Md ± IQR 7.00 ± 2.00 8.00 ± 2.00 8.00 ± 2.00 9.00 ± 2.00 PP (mm) M ± SD 7.00 ± 1.00 7.42 ± 1.18 7.67 ± 0.92 8.33 ± 0.80 < 0.001 Md ± IQR 7.00 ± 0.00 8.00 ± 1.00 8.00 ± 1.00 9.00 ± 1.00 LVEF – Simpson (%) M ± SD 66.64 ± 3.83 62.46 ± 3.60 63.55 ± 4.10 64.17 ± 3.50 0.030 Md ± IQR 67.00 ± 5.00 62.00 ± 5.00 63.00 ± 6.00 64.00 ± 6.00 LV mass index (g/m 2 ) M ± SD 82.23 ± 16.76 104.49 ± 24.01 90.01 ± 19.54 108.12 ± 14.25 < 0.001 Md ± IQR 82.28 ± 13.59 106.35 ± 37.69 89.34 ± 26.89 110.61 ± 18.10 E/A ratio M ± SD 1.46 ± 0.40 1.33 ± 0.34 1.52 ± 0.41 1.18 ± 0.07 < 0.001 Md ± IQR 1.34 ± 0.38 1.30 ± 0.22 1.50 ± 0.44 1.18 ± 0.09 E’ septal annulus (cm/s) M ± SD 9.55 ± 1.87 9.03 ± 1.91 10.54 ± 2.21 8.38 ± 0.41 < 0.001 Md ± IQR 9.00 ± 1.90 8.35 ± 2.00 10.00 ± 3.00 8.15 ± 0.60 S’ septal annulus (cm/s) M ± SD 8.25 ± 1.09 8.10 ± 0.68 8.49 ± 1.41 9.03 ± 0.95 0.001 Md ± IQR 8.00 ± 2.00 8.00 ± 0.40 8.10 ± 1.00 8.80 ± 0.60 E/E’ ratio M ± SD 8.41 ± 1.33 8.72 ± 2.03 7.08 ± 1.65 9.29 ± 0.62 < 0.001 Md ± IQR 8.40 ± 2.59 9.08 ± 3.04 7.27 ± 2.45 9.38 ± 0.88 LA volume index (ml/m²) M ± SD 30.38 ± 6.16 29.93 ± 4.76 29.48 ± 5.60 29.56 ± 1.81 0.839 Md ± IQR 29.11 ± 1.09 30.40 ± 3.48 29.17 ± 7.32 29.88 ± 2.76 S lateral tricuspid annulus (cm/s) M ± SD 11.29 ± 1.54 10.87 ± 1.42 12.23 ± 1.90 11.49 ± 0.90 0.014 Md ± IQR 11.00 ± 2.00 10.80 ± 2.00 12.00 ± 2.00 11.70 ± 0.50 M: mean; SD: standard deviation; Md: median; IQR: interquartile range; ST: HIV+ patient not using antiretroviral therapy. PI: HIV-positive patients on protease inhibitor therapy; NNRTI: HIV-positive patients on non-nucleoside reverse transcriptase inhibitor therapy. LVDD: left ventricular diastolic diameter; LVSD: left ventricular systolic diameter; ΔD%: left ventricle; LA: left atrium Global longitudinal strain Table 3 shows the GLS in the different groups. Mean SLG was lower in the HIV groups compared to controls (p < 0.05). There were no differences between groups of HIV-infected patients. No statistically significant differences were identified between longitudinal, circumferential and radial strain rates between the groups of HIV-infected patients and controls. Discussion The purpose of our study was to identify subclinical left ventricular dysfunction using speckle tracking. HIV+ patients were asymptomatic from the cardiovascular point of view and had normal LV systolic function by conventional echocardiographic analysis based on LV ejection fraction. This study demonstrated that patients with HIV infection, even those not on ART, present longitudinal myocardial strain abnormalities assessed by speckle tracking. These findings confirm previous observations 13 and extend them by assessing the impact of new therapeutic protocols. Cardiovascular manifestations of HIV infection were altered by the introduction of ART, which significantly modified the course of HIV infection, decreasing mortality and improving the quality of life of infected patients. On the other hand, data from multiple studies raised the concern that ART would be associated with an increase in peripheral and coronary artery disease. The clinical manifestations associated with ART are frequent and must be followed up by the multidisciplinary teams assisting these patients. 14 This study suggests that subclinical left ventricular dysfunction should be investigated whenever possible. 741