Postmortem cardiomegaly and echocardiographic measurements of left ventricular size and function in children infected with the human immunodeficiency virus: The Prospective P²C² HIV Multicenter Study

Background: Cardiomegaly, seen postmortem in over 50% of HIV-infected children, may occur in the absence of clinical or histopathologic cardiac disease. Premortem echocardiography has also demonstrated clinical and subclinical cardiac disease, including increased left ventricular mass (LVM) and functional abnormalities. No studies have compared these echocardiographic measures of heart size and function with postmortem findings in this population. We sought to determine the postmortem prevalence, clinicopathologic relationships and importance of cardiomegaly in HIV-infected children. Methods: We reviewed clinical and postmortem cardiac findings in 30 HIV-infected children who were part of the Prospective P²C² HIV Study. Postmortem heart weight was compared with clinical measures of heart size and function, with cardiac pathology and with clinical measures reflecting chronic effects of HIV disease. Results: Postmortem cardiomegaly (heart weight z score ≥2) was identified in 53% of the children. Children with cardiomegaly had increased LVM, increased heart rate, more frequent clinical chronic heart disease and a higher prevalence of postmortem pericardial effusions compared to children without cardiomegaly (P≤.05). The association with LV end-diastolic dimension (LVEDD) did not reach statistical significance (P=.08). No association was found with LV posterior wall thickness (LVPWT), CD4⁺ T-cell counts, HIV-1 viral load, hemoglobin, encephalopathy, myocardial histology or myocardial organisms. Conclusions: Postmortem cardiomegaly was associated with echocardiographic measures of increased LVM. The pathogenesis appears not to be related to chronic anemia, HIV viral load, the degree of immune suppression or encephalopathy. Autonomic dysregulation, reflected by chronically increased heart rate, may be of pathoetiologic significance.