Background: Increased left ventricular (LV) mass and decreased fractional shortening are associated with mortality in Human Immunodeficiency Virus (HIV) seropositive infants and children. We hypothesized that cardiac biomarkers would be associated with abnormal cardiac structure and function in HIV-seronegative children born to HIV-seropositive mothers.
Methods: We analyzed serial paired observations of cardiac biomarkers and echocardiograms in 273 HIV-seronegative children (ages 0-58 months), exposed to HIV in utero. were log-transformed. Linear associations between 425 serial paired biomarker values [N-terminal probrain natriuretic peptide (NT-proBNP), high sensitivity C-reactive protein (HsCRP) and cardiac troponin T (cTnT) levels] and ECHO parameters z-scores were analyzed using generalized estimating equations (GEE) and were also dichotomized and the Cochran-Mantel-Haenszel test was used to assess associations between them.
Results: In the linear analyses, elevated NT-proBNP levels were associated with increased LV mass (p= 0.053) and there was a trend toward a significant association between elevated cTnT levels at birth and decreased LV fractional shortening (p=0.068). In the categorical analyses, elevated cTnT levels (> 0.01 ng/mL) were significantly associated with a cardiac intraventricular septal wall thickness z-score > 2 (OR= 9.16; 95% CI 1.24-67.41; p=0.007). Conclusions: Our findings indicate significant or borderline significant associations between abnormal cardiac biomarker levels (NT-proBNP and cTnT) and increased LV mass and cardiac septal wall thickness and decreased LV function (fractional shortening). Cardiac biomarkers may be a resource-efficient modality in monitoring the cardiac status of children exposed to HIV in utero and also identify those children who require a more complete cardiac evaluation.