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M9610536.TXT
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1996-01-30
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Document 0536
DOCN M9610536
TI Immunoglobulins and left ventricular structure and function in pediatric
HIV infection.
DT 9601
AU Lipshultz SE; Orav EJ; Sanders SP; Colan SD; Department of Cardiology,
Children's Hospital, Boston, MA 02115,; USA.
SO Circulation. 1995 Oct 15;92(8):2220-5. Unique Identifier : AIDSLINE
MED/96017301
AB BACKGROUND: Progressive left ventricular (LV) dilation is common in
children infected with HIV-1 and may be a harbinger of congestive heart
failure (CHF). In many HIV-infected children, dilation is associated
with inadequate LV hypertrophy, elevated afterload, and reduced LV
function. Because CHF has been observed empirically to improve after
treatment with intravenous immunoglobulin (IVIG) in other conditions and
because LV dysfunction in pediatric HIV may be immunologically mediated,
we examined retrospectively the relation between immunoglobulins and LV
structure and function in 49 HIV-infected infants and children without
CHF. METHODS AND RESULTS: A total of 106 echocardiograms were performed
in these children within 30 days of serum immunoglobulin (IgG, IgA, and
IgM) measurements; this includes 12 children treated with IVIG therapy.
All echocardiographic parameters, blood pressures, and immunoglobulins
were adjusted for age or body surface area and subjected to
repeated-measures regression. Regression models were adjusted
simultaneously for endogenous IgA, IgG, IgM, IVIG therapy, zidovudine
therapy, age, HIV disease stage, and weight. Higher endogenous serum IgG
levels and IVIG treatment were associated with significantly greater
wall thickness and lower peak wall stress. Higher endogenous serum IgA
levels were associated with more normal LV wall thickness and LV
thickness-to-dimension ratios. LV contractility, fractional shortening,
end-systolic wall stress, and thickness-to-dimension ratio all showed a
trend toward more normal values with higher endogenous immunoglobulin
values or during IVIG treatment. CONCLUSIONS: LV structure and function
appear to be more normal in HIV-infected children who receive IVIG
treatment and in those with higher endogenous IgG levels. These results
suggest that both the impaired myocardial growth and the LV dysfunction
observed may be immunologically mediated and responsive to
immunomodulatory therapy.
DE Case-Control Studies Child Child, Preschool Cohort Studies
Echocardiography Human Hypertrophy, Left
Ventricular/*ETIOLOGY/PHYSIOPATHOLOGY/ ULTRASONOGRAPHY HIV
Infections/COMPLICATIONS/*PHYSIOPATHOLOGY/*THERAPY
Immunoglobulins/*BLOOD Immunoglobulins, Intravenous/*THERAPEUTIC USE
Multivariate Analysis Support, Non-U.S. Gov't Support, U.S. Gov't,
P.H.S. Ventricular Dysfunction, Left/*ETIOLOGY/PHYSIOPATHOLOGY/
ULTRASONOGRAPHY Ventricular Function, Left/*PHYSIOLOGY JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).