Quantification of cardiac structure and function using transthoracic echocardiography in term women with HIV

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dc.contributor.advisorDennis, A Ten_ZA
dc.contributor.advisorDyer, Robert Aen_ZA
dc.contributor.authorGibbs, Matthew Wintonen_ZA
dc.date.accessioned2017-06-06T09:36:48Z
dc.date.available2017-06-06T09:36:48Z
dc.date.issued2017en_ZA
dc.description.abstractIntroduction: In South Africa, up to 30% of pregnant women are human immunodeficiency virus (HIV) positive and morbidity and mortality is high in this group. HIV positive men and women may have multiple cardiovascular comorbidities, which include systolic dysfunction that may progress to heart failure secondary to dilated cardiomyopathy. However the concurrent effect of pregnancy and HIV infection on haemodynamics has not been extensively researched. The aims of this study were to quantify haemodynamics using transthoracic echocardiography (TTE) in term pregnant women with HIV on antiretroviral (ARV) treatment and compare the data with term healthy women in the same population. Method: After ethics approval and written consent, 30 consecutive term HIV positive women and 40 healthy term pregnant women were recruited. HIV positive women had a CD4 count greater than 200 and were either on Highly Active Anti-Retroviral Therapy (HAART) or single drug management. Results: Haemodynamic assessment was possible in all patients and women in the two groups were similar in age, and body mass index. Mean CD4 count was 452 ± 187.8 and duration of therapy was 15.9 ± 22.4 months. Compared with healthy pregnant women, women with HIV have systolic changes exhibited by reductions in left ventricle (LV) septal and right ventricle (RV) systolic myocardial velocities as well as increased LV end-diastolic (ED) areas and diastolic changes of increased RV isovolumetric (IV) relaxation and reduced RV e′ diastolic myocardial velocities. These changes occur in the presence of a reduced LV mass. Pericardial effusions occurred more frequently and are of a larger size in women with HIV. These findings suggest subclinical impairment of systolic function in the LV as well as subclinical impairment of both systolic and diastolic function in the RV. Discussion: Transthoracic echocardiography can quantify cardiac function in healthy pregnant women and in pregnant women with HIV and is acceptable to the patients. HIV positive pregnant women at term on anti-retroviral therapy have hearts that have subclinical systolic dysfunction in the presence of decreased LV mass and increased end-diastolic areas. This may represent a failure to compensate for the increased haemodynamic demands of pregnancy and may be as a result of the direct effects of HIV itself or due to anti-retroviral drugs.en_ZA
dc.identifier.apacitationGibbs, M. W. (2017). <i>Quantification of cardiac structure and function using transthoracic echocardiography in term women with HIV</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Anaesthesia. Retrieved from http://hdl.handle.net/11427/24486en_ZA
dc.identifier.chicagocitationGibbs, Matthew Winton. <i>"Quantification of cardiac structure and function using transthoracic echocardiography in term women with HIV."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Anaesthesia, 2017. http://hdl.handle.net/11427/24486en_ZA
dc.identifier.citationGibbs, M. 2017. Quantification of cardiac structure and function using transthoracic echocardiography in term women with HIV. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Gibbs, Matthew Winton AB - Introduction: In South Africa, up to 30% of pregnant women are human immunodeficiency virus (HIV) positive and morbidity and mortality is high in this group. HIV positive men and women may have multiple cardiovascular comorbidities, which include systolic dysfunction that may progress to heart failure secondary to dilated cardiomyopathy. However the concurrent effect of pregnancy and HIV infection on haemodynamics has not been extensively researched. The aims of this study were to quantify haemodynamics using transthoracic echocardiography (TTE) in term pregnant women with HIV on antiretroviral (ARV) treatment and compare the data with term healthy women in the same population. Method: After ethics approval and written consent, 30 consecutive term HIV positive women and 40 healthy term pregnant women were recruited. HIV positive women had a CD4 count greater than 200 and were either on Highly Active Anti-Retroviral Therapy (HAART) or single drug management. Results: Haemodynamic assessment was possible in all patients and women in the two groups were similar in age, and body mass index. Mean CD4 count was 452 ± 187.8 and duration of therapy was 15.9 ± 22.4 months. Compared with healthy pregnant women, women with HIV have systolic changes exhibited by reductions in left ventricle (LV) septal and right ventricle (RV) systolic myocardial velocities as well as increased LV end-diastolic (ED) areas and diastolic changes of increased RV isovolumetric (IV) relaxation and reduced RV e′ diastolic myocardial velocities. These changes occur in the presence of a reduced LV mass. Pericardial effusions occurred more frequently and are of a larger size in women with HIV. These findings suggest subclinical impairment of systolic function in the LV as well as subclinical impairment of both systolic and diastolic function in the RV. Discussion: Transthoracic echocardiography can quantify cardiac function in healthy pregnant women and in pregnant women with HIV and is acceptable to the patients. HIV positive pregnant women at term on anti-retroviral therapy have hearts that have subclinical systolic dysfunction in the presence of decreased LV mass and increased end-diastolic areas. This may represent a failure to compensate for the increased haemodynamic demands of pregnancy and may be as a result of the direct effects of HIV itself or due to anti-retroviral drugs. DA - 2017 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2017 T1 - Quantification of cardiac structure and function using transthoracic echocardiography in term women with HIV TI - Quantification of cardiac structure and function using transthoracic echocardiography in term women with HIV UR - http://hdl.handle.net/11427/24486 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/24486
dc.identifier.vancouvercitationGibbs MW. Quantification of cardiac structure and function using transthoracic echocardiography in term women with HIV. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Anaesthesia, 2017 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/24486en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDepartment of Anaesthesiaen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherAnaesthesiaen_ZA
dc.titleQuantification of cardiac structure and function using transthoracic echocardiography in term women with HIVen_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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