Cardiac Structure and Function in HIV-Infected Children

To the Editor: Lipshultz and colleagues (Oct. 29 issue)¹ studied cardiac dimensions and function in children infected with the human immunodeficiency virus (HIV) and concluded that progressive left ventricular dilatation occurred independently of any effect of zidovudine. That conclusion may not be warranted. Ejection performance (measured as fractional shortening) was normal in their patients at the start of zidovudine therapy but was depressed after therapy, as their Table 1 shows. Ejection performance declined, whereas contractility was unchanged. The causative factor appeared to be an increase in afterload (defined as end-systolic wall stress) despite increased posterior-wall thickness and left ventricular mass…