Abstract
The number of children with symptomatic human immunodeficiency virus syndrome-related cardiac disease is increasing, as children live longer secondary to improved treatment. There is increased morbidity and mortality in the subpopulation of infants and children with congestive heart failure secondary to left ventricular dysfunction. Left ventricular dysfunction is characterized by left ventricular dilatation and decreased wall thickness, resulting in inadequate left ventricular hypertrophy. The clinical course of these infants and children can be improved by treatments such as intravenous gammaglobulin, which is known to normalize left ventricular structure and function in this subpopulation, provided treatment is implemented early in the course of the cardiac disease. It is therefore necessary to be able to identify those high risk patients by non-invasive methods, such as echocardiography. Nearly all published investigations examining left ventricular performance in human immunodeficiency virus-infected patients have used measurements, such as left ventricular fractional shortening, that depend on both preload and afterload. These measurements may determine who requires the need for intervention; fractional shortening may determine who is treated in protocols implemented by the AIDS Clinical Trial Group. Numerous studies have documented that fractional shortening may not be a sufficiently reliable indicator of intrinsic myocardial function in human immunodeficiency virus-infected infants and children. Contractility may not be accurately described by fractional shortening in these patients, who tend to have abnormal preload and afterload. The magnitude of the discrepancy between fractional shortening and contractility must be taken into consideration when treating infants and children infected with the human immunodeficiency virus.
