Viral Cardiomyopathy

[bobino]

A friend of mine who is very treatment experienced recently had a stress test which showed that his "ejection fraction" was markedly reduced.  His doctor told him it was likely "viral cardiomyopathy." 

I've never heard of this.  Does anyone know whether it is a treatment side effect or caused by HIV itself?  If it is a treatment side-effect, do you know which drugs cause it?

Thanks much,

John

[trellium]

Hi John,

I think it can be caused by both HIV and long-term use of HAART medications, especially the ones that elevate cholesterol and triglycerides levels.


From the Mayo Clinic:

What does the term "ejection fraction" mean? What does it measure?

During each heartbeat cycle, the heart contracts and relaxes. When your heart contracts (systole), it ejects blood from the two pumping chambers (ventricles). When your heart relaxes (diastole), the ventricles refill with blood. No matter how forceful the contraction, it doesn't empty all of the blood out of a ventricle. The term "ejection fraction" refers to the percentage of blood that's pumped out of a filled ventricle with each heartbeat. This measures the capacity at which your heart is pumping.

Because the left ventricle is the heart's main pumping chamber, ejection fraction is usually measured only in the left ventricle (LV). A normal LV ejection fraction is 55 percent to 70 percent. The ejection fraction may decrease when the heart muscle has been damaged, such as due to:

    * Heart attack
    * Heart-muscle disease (cardiomyopathy)
    * Heart valve problems

A doctor can measure ejection fraction by several methods, including:

    * An ultrasound of the heart (echocardiography)
    * Cardiac catheterization (left ventriculogram)
    * A magnetic resonance imaging (MRI) scan of the heart
    * A nuclear medicine scan (multiple gated acquisition, or MUGA) of the heart
    * A computerized tomography (CT) scan of the heart

http://www.mayoclinic.com/health/ejection-fraction/AN00360


Below is an article from Aidsmap regarding Cardiomyopathy

Cardiomyopathy means heart disease of unknown cause. One form of cardiomyopathy called dilated cardiomyopathy, is characterised by poor contraction of the heart muscles. Recent reports have found that people with HIV have a high rate of dilated cardiomyopathy and that HIV may be a cause of that condition.

Dilated cardiomyopathy is suggestive of a poorer prognosis among people with HIV disease. HIV-infected people also have higher than average rates of left ventricular hypertrophy - a condition where the heart swells to compensate for its increasing weakness.

Regular heart and lung check-ups may allow early diagnosis and treatment of heart conditions.



Mechanism and risk factors
The role HIV plays in the development of heart disease is not understood. It may directly impact on heart cells, or induce disease through the dysregulation of the immune system or coinfection with other viruses. Poor nutrition and wasting may also contribute to heart disease, and anecdotal reports have suggested that antiretroviral therapy including protease inhibitors may increase a person's risk of heart disease.

Key research


Barbaro undertook a long-term, prospective study to assess the incidence of dilated cardiomyopathy among people with HIV and to analyse clinical factors influencing its development. 952 HIV-positive people were followed for an average of 60 months. 76 (8%) were diagnosed with dilated cardiomyopathy, of whom 63 also had myocarditis (inflammation of the muscle in the heart wall). Researchers did not determine the causal mechanism but suggested two possibilities: the direct action of HIV on the heart, or an autoimmune process induced by HIV, possibly in conjunction with other viruses such as EBV or CMV.

References


Barbaro G et al. Incidence of dilated cardiomyopathy and detection of HIV in myocardial cells of HIV-positive patients. Gruppo Italiano per lo studio cardiologico dei pazienti affetti da AIDS. New England Journal of Medicine 339(16): 1093-1099, 1998.

Lipshultz SE. Dilated cardiomyopathy in HIV-infected patients. New England Journal of Medicine 339(16): 1153-1155, 1998.

http://www.aidsmap.com/en/docs/111B8A8F-333B-4264-BD70-238DF69E155D.asp

[bobino]

Dear Trellium,

Thanks so much for the info.  I've passed it along to my friend.  It doesn't exactly look encouraging, to be honest, but I guess having information is better than remaining ignorant.

Again, thanks for the information.  I really appreciate it.

John

[trellium]

Hi John,

you're welcome!
Hopefully the cardiologist can recommend the best treatment for his condition.

here are some treatment option info you can pass along to your friend:

How Is Cardiomyopathy Treated?
http://www.nhlbi.nih.gov/health/dci/Diseases/cm/cm_treatments.html

From the Mayo Clinic section on treatment for Cardiomyopathy
http://www.mayoclinic.com/health/cardiomyopathy/DS00519/DSECTION=7

[bobino]

Trellium,

Thanks once again.  Fortunately, I'm not worried about my friend receiving the proper treatment.  He lives in New York and has excellent care.  In fact, he's a doctor himself, but for some reason he can't seem to deal with his own disease, so he asked me to do some legwork for him.  It's funny how this virus affects us -- both physically and mentally.

John

[randym431]

Oh... Great... ANother something new to worry about with this virus.