Introduction
The heart and great vessels are not the sites most frequently affected by opportunistic infections or tumors in patients with AIDS. However, cardiovascular complications are relatively common and may be responsible for sudden death.
A wide spectrum of cardiovascular complications have been reported in HIV infection and AIDS, which may be depicted at imaging, including pericardial disease with effusion and tamponade, nonspecific or infectious myocarditis, dilated cardiomyopathy with global left ventricular dysfunction, endocardial valvular disease due to marantic or infective endocarditis, arrhythmias, human immunodeficiency virus-associated pulmonary hypertension, thrombosis, embolism, vasculitis, coronary artery disease, aneurysm, and cardiac involvement in AIDS-related tumors. However, more specifically, myocardial involvement in HIV seropositive patients is multifactorial and associated with increased morbidity and mortality. Classically, a variety of potential aetiologies have been postulated in HIV-related myocardial diseases, ultimately leading to cardiomyopathy, which include myocardial infection with HIV itself, opportunistic infections, viral infections, autoimmune response to viral infection, drug-related cardiotoxicity, ischemic myocardial damage, nutritional deficiencies, and prolonged immunosuppression. Of note, the epidemiology has changed dramatically since the introduction of highly active antiretroviral therapy (HAART). Coronary artery disease and dyslipidaemia, drug- related cardiotoxicity and cardiac autonomic dysfunction are becoming increasingly prevalent.Recent developments of cardiac magnetic resonance (CMR) imaging have led to tremendous breakthrough in functional imaging and tissue characterization of the left (LV) and right (RV) ventricular myocardium. Advances in hardware, acquisition sequences and coil technology have greatly contributed to the improvement of image quality while simplifying cardiac examinations, thereby offering new possibilities for the characterization of myocardial diseases.
Cine-CMR allows for accurate time-resolved imaging of global and segmental LV and RV function with high spatial resolution. Dynamic multislice CMR of myocardial perfusion is very useful for diagnosis of coronary artery disease (CAD). In addition, gadolinium-based contrast CMR with the so- called late enhancement technique has shown great value for non-invasive imaging of myocardial infarction and myocarditis. According to reports of clinical and autopsy studies, the prevalence of myocardial abnormalities in HIV-positive patients ranges from 25 to 75% [1, 2].In this chapter, we will review myocardial diseases that may occur in HIV-positive patients, focusing on dilated cardiomyopathy, ischemic heart disease, and myocarditis, while excluding endocardial, pericardial and pericardiac diseases. We will not address non-invasive coronary MR angiography that is currently not a routine tool for imaging of the coronary arteries and there
is no data on the particular coronary disease of HIV patients. Also, myocardial involvement in Kaposi sarcoma or lymphoma, as well as the hypertrophy of the right ventricle in response to AIDS-related pulmonary disease will not be detailed [2].
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