Cardiovascular magnetic resonance characterisation of myocardial involvement in tuberculous pericardial constriction with and without HIV co-infection

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dc.contributor.advisorNtusi, Ntobeko A Ben_ZA
dc.contributor.authorPalkowski, Gregori Hen_ZA
dc.date.accessioned2017-01-27T14:21:44Z
dc.date.available2017-01-27T14:21:44Z
dc.date.issued2016en_ZA
dc.description.abstractBackground:Tuberculous pericarditis includes the spectrum of pericarditis caused by Mycobacterium tuberculosis manifesting with pericardial effusion, cardiac tamponade, effusive-constrictive and constrictive pericarditis. In patients with pericardial tuberculosis, co-infection with human immunodeficiency virus (HIV) is associated with increased incidence of haemodynamic instability, electrocardiographic (ECG) ST elevation and mortality, suggesting an aggressive myopericarditis. However, little is known about myocardial involvement in patients with pericardial tuberculosis. Cardiovascular magnetic resonance (CMR) can assess non-invasively cardiac function, myocardial oedema, inflammation and fibrosis. Objectives: To assess cardiac and pericardial structure and function in patients with TBPC with and without HIV co-infection and to assess the relationship of left ventricular (LV) function with other imaging biomarkers. Methods: 72 patients with TBPC (37 male (51.3%), mean age 40 ± 14.3) were included in the study. Of these, 35 were HIV infected (17 male (48.6%), mean age 34 ± 8) and 37 were HIV uninfected (20 male (54.1%), mean age 51 ± 16). Assessments included clinical examination, ECG, echocardiography, serum and pericardial biomarkers and CMR (biventricular volumes and function, oedema, and late gadolinium enhancement - LGE). Results: HIV infected TBPC patients were younger (p<0.001), had lower serum haemoglobin (p<0.001) and were more likely to have NYHA class III and IV symptoms (p<0.001). There were no differences on ECG and echocardiography between HIV infected and uninfected TBPC patients. There were also no differences in global systolic function between HIV infected and uninfected TBP patients. Focal fibrosis on LGE was found more commonly in those with HIV infection (p<0.001). Pericardial effusions were frequent (>50%) in both groups of TBPC patients. Determinants of LV ejection fraction in TBPC included heart rate, LV size, E/A ratio, pericardial LGE and pericardial thickness (all p<0.01). Conclusions: HIV co-infection is associated with increased focal myocardial fibrosis in TBPC patients suggesting increased myocardial inflammation in those with HIV co-infection. In the future, it will be important to assess the prognostic significance of these findings.en_ZA
dc.identifier.apacitationPalkowski, G. H. (2016). <i>Cardiovascular magnetic resonance characterisation of myocardial involvement in tuberculous pericardial constriction with and without HIV co-infection</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Medicine. Retrieved from http://hdl.handle.net/11427/23659en_ZA
dc.identifier.chicagocitationPalkowski, Gregori H. <i>"Cardiovascular magnetic resonance characterisation of myocardial involvement in tuberculous pericardial constriction with and without HIV co-infection."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2016. http://hdl.handle.net/11427/23659en_ZA
dc.identifier.citationPalkowski, G. 2016. Cardiovascular magnetic resonance characterisation of myocardial involvement in tuberculous pericardial constriction with and without HIV co-infection. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Palkowski, Gregori H AB - Background:Tuberculous pericarditis includes the spectrum of pericarditis caused by Mycobacterium tuberculosis manifesting with pericardial effusion, cardiac tamponade, effusive-constrictive and constrictive pericarditis. In patients with pericardial tuberculosis, co-infection with human immunodeficiency virus (HIV) is associated with increased incidence of haemodynamic instability, electrocardiographic (ECG) ST elevation and mortality, suggesting an aggressive myopericarditis. However, little is known about myocardial involvement in patients with pericardial tuberculosis. Cardiovascular magnetic resonance (CMR) can assess non-invasively cardiac function, myocardial oedema, inflammation and fibrosis. Objectives: To assess cardiac and pericardial structure and function in patients with TBPC with and without HIV co-infection and to assess the relationship of left ventricular (LV) function with other imaging biomarkers. Methods: 72 patients with TBPC (37 male (51.3%), mean age 40 ± 14.3) were included in the study. Of these, 35 were HIV infected (17 male (48.6%), mean age 34 ± 8) and 37 were HIV uninfected (20 male (54.1%), mean age 51 ± 16). Assessments included clinical examination, ECG, echocardiography, serum and pericardial biomarkers and CMR (biventricular volumes and function, oedema, and late gadolinium enhancement - LGE). Results: HIV infected TBPC patients were younger (p<0.001), had lower serum haemoglobin (p<0.001) and were more likely to have NYHA class III and IV symptoms (p<0.001). There were no differences on ECG and echocardiography between HIV infected and uninfected TBPC patients. There were also no differences in global systolic function between HIV infected and uninfected TBP patients. Focal fibrosis on LGE was found more commonly in those with HIV infection (p<0.001). Pericardial effusions were frequent (>50%) in both groups of TBPC patients. Determinants of LV ejection fraction in TBPC included heart rate, LV size, E/A ratio, pericardial LGE and pericardial thickness (all p<0.01). Conclusions: HIV co-infection is associated with increased focal myocardial fibrosis in TBPC patients suggesting increased myocardial inflammation in those with HIV co-infection. In the future, it will be important to assess the prognostic significance of these findings. DA - 2016 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 T1 - Cardiovascular magnetic resonance characterisation of myocardial involvement in tuberculous pericardial constriction with and without HIV co-infection TI - Cardiovascular magnetic resonance characterisation of myocardial involvement in tuberculous pericardial constriction with and without HIV co-infection UR - http://hdl.handle.net/11427/23659 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/23659
dc.identifier.vancouvercitationPalkowski GH. Cardiovascular magnetic resonance characterisation of myocardial involvement in tuberculous pericardial constriction with and without HIV co-infection. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2016 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/23659en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDepartment of Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherMedicineen_ZA
dc.titleCardiovascular magnetic resonance characterisation of myocardial involvement in tuberculous pericardial constriction with and without HIV co-infectionen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMMeden_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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