DOI: 10.5061/dryad.v6wwpzgt8
title: Right ventricular contractility and load in HIV associated pulmonary hypertension

description: Background: People living with human immunodeficiency virus (PLWH) are at
 risk of developing pulmonary hypertension (PH) and right ventricular (RV)
 dysfunction, but understanding of the relationship of RV function to
 afterload (RV-PA coupling) is limited. We evaluated the clinical and
 hemodynamic characteristics of human immunodeficiency virus
 (HIV)-associated PH. Methods: We performed a retrospective review of
 patients with a diagnosis of HIV undergoing right heart catheterization
 (RHC) from 2000-2016 in a tertiary care center. Inclusion criteria were
 diagnosis of HIV, age ≥ 18 years and availability of RHC data. PH was
 classified as either pulmonary arterial hypertension (PAH; mean pulmonary
 arterial pressure [mPAP] ≥ 25mmHg with pulmonary artery wedge pressure
 [PAWP] ≤ 15mmHg) or pulmonary venous hypertension (PVH; mPAP ≥ 25mmHg with
 PAWP &gt; 15). We collected demographics, CD4 cell count, HIV
 viral load, RHC and echocardiographic data. The single beat method was
 used to calculate RV-PA coupling from RHC. Results: Sixty-two PLWH with a
 clinical likelihood for PH underwent RHC. Thirty-two (52%) met PH criteria
 (15 with PAH, 17 with PVH). Average time from diagnosis of HIV to
 diagnosis of PH was 11 years. Eleven of 15 individuals with PAH were on
 antiretroviral therapy (ART) while all 17 patients with PVH were on ART.
 Compared to PLWH without PH, those with PH had an increased likelihood of
 having a detectable HIV viral load and lower CD4 cell counts. PLWH with
 PAH or PVH had increased RV afterload with normal RV contractility, and
 preserved RV-PA coupling.  Conclusion: PLWH with PH (PAH or PVH)
 were more likely to have a detectable HIV viral load and lower CD4 count
 at the time of RHC. PLWH with PAH or PVH had increased RV afterload,
 normal RV contractility, with preserved RV-PA coupling suggestive of an
 early onset, mild, and compensated form of PH. These results should be
 confirmed in larger studies.
description: Subjects were selected from a de-identified database of all patients who underwent a right heart catheterization (RHC) at the University of Pittsburgh Medical Center between 2000 and 2016. We selected individuals with a diagnosis of HIV (ICD-9 code: 042) in the Electronic Health Record. Patients were categorized into 2 groups:  Pulmonary Hypertension (PH, defined as mean pulmonary arterial pressure [mPAP] ≥ 25mmHg) and No Pulmonary Hypertension (No PH, defined as mPAP≤ 25mmHg). PH was further sub-categorized as either pulmonary arterial hypertension (PAH; defined as mPAP ≥ 25mmHg with pulmonary artery wedge pressure [PAWP] ≤ 15mmHg) or pulmonary venous hypertension (PVH; defined as mPAP ≥ 25mmHg with PAWP &gt; 15). Data collected included demographics, medical history, medications, CD4 cell count, and HIV viral load. We analyzed echocardiographic and cardiac catheterization data that were collected within 6 months of each other for complete LV systolic and diastolic measurements and RV systolic measurements. The IRB of the University of Pittsburgh approved the study.
description: <b>Table S1.</b> Missing data for subject characteristics         <b>No Pulmonary Hypertension</b> N=30   <b>Pulmonary Hypertension</b> N=32       <b>Age (years)</b> 0 0 <b>Female</b> 0 0 <b>African-American</b> 1 1 <b>CAD</b> 0 0 <b>IVDU</b> 0 0 <b>History of Smoking </b> 0 0 <b>Hypertension</b> 0 0 <b>Vasodilator use</b> 0 6 (40%) 0 3 (18%) <b>Anti-retroviral use</b> 0 0 <b>CD4 &lt;400 </b> 4 6 <b>CD4 count </b><b>(</b><b>cells/mm</b><b>3</b><b>)</b> 4 6   <b>Table S2.</b> Missing data for hemodynamic and echocardiographic data.     <b>No Pulmonary Hypertension </b> N=30 <b>Pulmonary Hypertension </b> N=32 <b>Heart rate (bpm) </b> 13 15 <b>ePASP (mmHg)  </b> 7 9 <b>EF</b><b> (%)  </b> 3 5 <b>RVOT VTI</b><b><sup> </sup></b><b>(</b><b>m</b><b>)</b> 15 16 <b>mPAAT</b><b><sup> </sup></b><b>(</b><b>cm</b><b>)</b> 16 16 <b>TAPSE</b><b><sup> </sup></b><b>(</b><b>cm</b><b>)</b> 14 16 <b>FAC</b><b><sup> </sup></b><b>(%)</b> 17                 16 <b>MPAP</b><b><sup> </sup></b><b>(</b><b>mmHg</b><b>)</b> 3 5 <b>PAWP</b><b><sup> </sup></b><b>(</b><b>mmHg</b><b>)</b> 3 7 <b>C</b><b>O</b><b><sup> </sup></b><b>(</b><b>L/min</b><b>/m</b><b><sup>2</sup></b><b>)</b> 7 6 <b>PVR</b><b><sup> </sup></b><b>(</b><b>Woods Units</b><b>)</b> 9 8 <b>Ees</b><b><sup> </sup></b><b>(</b><b>mmHg/mL</b><b>)*</b> 12 8 <b>E</b><b>a</b><b> (</b><b>mmHg/mL</b><b>)*</b> 12 8 <b>Ees/Ea*</b> 12 8 <b>Diastolic Stiffness</b><b>, </b><b>Beta</b><b><sup>,</sup></b><b>*</b> 12 8 * Single beat analysis was available for 18 patients in the No Pulmonary Hypertension group and 24 patients in the Pulmonary Hypertension group.     <b>Table S3.</b> Missing data for subject characteristics   <b>PAH</b> N= 15 <b>PVH</b> N=17       <b>Age (years)</b> 0 0 <b>Female</b> 0 0 <b>African-American</b> 1 1 <b>CAD</b> 0 0 <b>IVDU</b> 0 0 <b>History of Smoking </b> 0 0 <b>Hypertension</b> 0 0 <b>Vasodilator use</b> 0 6 (40%) 0 3 (18%) <b>Anti-retroviral use</b> 0 0 <b>CD4 &lt;400 </b> 2 4 <b>CD4 count </b><b>(</b><b>cells/mm</b><b>3</b><b>)</b> 2 4   <b>Table S4.</b> Missing data for hemodynamic and echocardiographic data.   <b>PAH</b> N=13 <b>PVH</b> N=14 <b>Heart rate</b><b><sup> </sup></b><b>(bpm) </b> 3 7 <b>ePASP</b><b><sup> </sup></b><b>(mmHg)  </b> 2 2 <b>EF</b><b><sup>2</sup></b><b> (%)  </b> 0 0 <b>RVOT VTI </b><b>(</b><b>m</b><b>)</b> 4 7 <b>mPAAT</b><b><sup> </sup></b><b>(</b><b>cm</b><b>)</b> 4 7 <b>TAPSE </b><b>(</b><b>cm</b><b>)</b> 4 7 <b>FAC</b><b><sup>1</sup></b><b> </b><b>(%)</b> 4                  7 <b>MPAP </b><b>(</b><b>mmHg</b><b>)</b> 0 0 <b>PAWP </b><b>(</b><b>mmHg</b><b>)</b> 2 0 <b>C</b><b>O</b><b><sup> </sup></b><b>(</b><b>L/min</b><b>/m</b><b><sup>2</sup></b><b>)</b> 2 1 <b>PVR</b><b><sup> </sup></b><b> </b><b>(</b><b>Woods Units</b><b>)</b> 2 1 <b>Ees</b><b><sup> </sup></b><b>(</b><b>mmHg/mL</b><b>)*</b> 3 7 <b>Ea</b><b><sup> </sup></b><b>(</b><b>mmHg/mL</b><b>)*</b> 3 7 <b>Ees/Ea</b><b><sup>2</sup></b><b>*</b> 3 7 <b>Diastolic Stiffness</b><b>, </b><b>Beta</b><b><sup>,</sup></b><b>*</b> 3 7 * Single beat analysis was available for 10 patients in the Pulmonary Arterial Hypertension group and 7 patients in the Pulmonary Venous Hypertension group.   Please note on the uploaded dataset the tab marked 'demographics', 'viral dais not patient linked to 'hemodynamics', given the differences in available data ( i.e sample number) and for concerns of sensitive data, and for ease of analysis.