We retrospectively reviewed M-mode echocardiograms performed for pediatric HIV infected (HIV+) and non-HIV infected patients presenting for cardiac evaluation in our institution.

Objective: To determine if abnormalities of cardiac diastolic function (DFx) occur in the presence of normal systolic function (SFx) in HIV+ children.

Methods: Of the 52 HIV+ children referred to our service between 1/1/94 to 4/30/95, 27 had adequate M-mode echo for the evaluation of DFx and SFx. Twelve of these patients had a previous M-mode echo available for comparison. During the same period 26 non-HIV infected patients who where within the same age range as the HIV+ patients and had normal cardiac anatomy and function served as the control group. Corrected velocity of fractional shortening (VCFc) for SFx and isovolumic relaxation time (IVRT) for DFx were measured. Normal value for VCFc was obtained from the literature (VCFc 1.01±0.11 circumferences/sec, mean±SD) and normal value for IVRT was obtained from the control group (33.9±4.9 ms).

Results: In the HIV+ group there were 15 males and 12 females(mean age 4.1 years, range 0.4-11.5). In the control group there were 12 males and 14 females (mean age 4.5 years, range 0.01-13.2). In the HIV+ group 11 had normal SFx and DFx and 14 had normal SFx but abnormal DFx. Six of the 12 patients who have had a previous M-Mode echocardiogram (mean time between echocardiograms: 1.9 years; range: 0.4-4.8), and continued to have normal SFx showed a further increase in IVRT (from 43 ± 8 ms to 62 ± 10 ms, p <0.05).

Conclusion: HIV+ patients with normal SFx may have abnormal DFx which appears to worsen over time, suggesting that prolonged IVRT may serve as an early marker for cardiac dysfunction. Therefore, we recommend that serial echocardiographic evaluation of SFx and DFx should be performed in HIV+ patients. We speculate that early pharmacological intervention at the onset of echocardiographic evidence of decreased DFx may improve morbidity and prolong survival in these patients.