Introduction

Echocardiography is an important imaging technique providing real-time imaging that can be performed at the bedside and easily repeated as needed (Table 1). Before the era of highly active anti-retroviral therapy

(HAART), cardiac complications in HIV included pericardial effusion, dilated car­diomyopathy, myocarditis, endocarditis, pul­monary hypertension, cardiac neoplasm, coronary artery disease and drug-related cardiotoxicity [1, 2].

Due to a better prophylaxis against opportunistic infections and as a result of longer survival due to the introduction of HAART therapy, non-infectious cardiovas­cular manifestations are more commonly detected [4]. Echocardiography can deter­mine left ventricular (LV), right ventricular (RV) systolic and diastolic functions, as well as the presence and severity of valvular heart disease (both stenosis and regurgita­tion), and pericardial disease. Doppler echocardiography can provide an accurate assessment of cardiac output, pulmonary artery pressures, resistance and filling pres­sures (Table 2). Echocardiography provides independent prognostic information on patients’ morbidity and survival. Echocar­diography is useful to detect cardiac abnor­malities both in symptomatic and asympto­matic patients. The recent introduction of new technologies such as Doppler myocar­dial imaging, strain and strain-rate and three-dimensional echocardiography could help in identifying subtle cardiac abnormal­ities at an asymptomatic stage.

Table 2 Main parameters derived from transthoracic echocardiography

Left ventricular dimensions and function

Left ventricular diameters and volumes (systole and diastole), wall thickness (diastole)

Left ventricular mass (indexed to BSA, height...)

Shortening fraction (N>30%) and left ventricular ejection fraction (N>60%)

Aortic output, Qs (N 5 at 6 l/min)

Transmitral flow

Left ventricular filling pressures (Ea and E/Ea; Vp and E/Vp; Ap-Am)

Valves

Thickness, leaflet mobility, calcifications, mass or vegetation (size, mobility)

If valvular stenosis: valvular area, maximal and mean gradient

If valvular regurgitation: mechanism, regurgitant orifice area, volume and fraction

Atria (left and right)

Size (diameters, area, volume); atrial mass or thrombus

Right ventricular dimensions and function

Right atrium and ventricle (diameter, area, volumes)

Right ventricular systolic function (fractional area, systolic velocity at tricuspid annulus)

Vena cava and hepatic veins (size, influence of respiration)

Right atrial pressure

Pulmonary pressures (systolic, diastolic, mean) and resistances

Pulmonary output, Qp (N 5 a 6 l/min)

Qp/Qs

Pericardium

Thickness, effusion, tolerance, hemodynamic consequences