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Evaluation of dyspnea of unknown etiology in HIV patients with cardiopulmonary exercise testing and cardiovascular magnetic resonance imaging

Authors :
Andrew J. Patterson
Anuja Sarode
Sadeer Al-Kindi
Lauren Shaver
Rahul Thomas
Evelyn Watson
Mohamad Amer Alaiti
Yuchi Liu
Jessie Hamilton
Nicole Seiberlich
Imran Rashid
Robert Gilkeson
Robert Schilz
Brian Hoit
Trevor Jenkins
Melissa Zullo
Eduardo Bossone
Christopher Longenecker
Orlando Simonetti
Sanjay Rajagopalan
Source :
Journal of Cardiovascular Magnetic Resonance, Vol 22, Iss 1, Pp 1-12 (2020)
Publication Year :
2020
Publisher :
Elsevier, 2020.

Abstract

Abstract Aim Human Immunodeficiency Virus (HIV) patients commonly experience dyspnea for which an immediate cause may not be always apparent. In this prospective cohort study of HIV patients with exercise limitation, we use cardiopulmonary exercise testing (CPET) coupled with exercise cardiovascular magnetic resonance (CMR) to elucidate etiologies of dyspnea. Methods and results Thirty-four HIV patients on antiretroviral therapy with dyspnea and exercise limitation (49.7 years, 65% male, mean absolute CD4 count 700) underwent comprehensive evaluation with combined rest and maximal exercise treadmill CMR and CPET. The overall mean oxygen consumption (VO2) peak was reduced at 23.2 ± 6.9 ml/kg/min with 20 patients (58.8% of overall cohort) achieving a respiratory exchange ratio > 1. The ventilatory efficiency (VE)/VCO2 slope was elevated at 36 ± 7.92, while ventilatory reserve (VE: maximal voluntary ventilation (MVV)) was within normal limits. The mean absolute right ventricular (RV) and left ventricular (LV) contractile reserves were preserved at 9.0% ± 11.2 and 9.4% ± 9.4, respectively. The average resting and post-exercise mean average pulmonary artery velocities were 12.2 ± 3.9 cm/s and 18.9 ± 8.3 respectively, which suggested lack of exercise induced pulmonary artery hypertension (PAH). LV but not RV delayed enhancement were identified in five patients. Correlation analysis found no relationship between peak VO2 measures of contractile RV or LV reserve, but LV and RV stroke volume correlated with PET CO2 (p = 0.02, p = 0.03). Conclusion Well treated patients with HIV appear to have conserved RV and LV function, contractile reserve and no evidence of exercise induced PAH. However, we found evidence of impaired ventilation suggesting a non-cardiopulmonary etiology for dyspnea.

Details

Language :
English
ISSN :
1532429X
Volume :
22
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Journal of Cardiovascular Magnetic Resonance
Publication Type :
Academic Journal
Accession number :
edsdoj.3079dccf5c884c02b14fa9625a0c6d13
Document Type :
article
Full Text :
https://doi.org/10.1186/s12968-020-00664-6