• Lipshultz, Steven E (PI)

Project: Research project

Project Details


The primary specific aims of this study are to 1) establish the incidence,
clinical spectrum, and natural history of cardiac dysautonomia as defined
by heart rate spectral analysis in both HIV infected and noninfected
children and 2) evaluate the value of heart rate spectral analysis for
predicting dysrhythmias and sudden death in infants and children born to
HIV infected mothers. The magnitude of clinical problems associated with
autonomic dysfunction in children with symptomatic HIV infection appears
to be great. Hemodynamic abnormalities, dysrhythmias, unexplained arrest
and/or sudden death are common in HIV+ children, especially when acute
deterioration, interventions or neurologic involvement is present. If this
proposed study establishes that cardiac dysautonomia is predictive of
adverse outcomes in HIV infected children, then a future prospective trial
of beta-adrenergic antagonist therapy may be warranted. This will be
accomplished by performing additional analysis of previously collected data
under the NHLBI-sponsored multicenter study entitled "Pediatric Pulmonary
and Cardiovascular Complications of Vertically Transmitted Human
Immunodeficiency Virus (HIV) Infection and abbreviated P2C2. The P2C2
study is being performed in a prospectively defined cohort of 150 children
with HIV infection and 350 uninfected control children born to HIV infected
women who have been followed since the first month of life to provide
understanding of cardiac dysautonomia in early HIV infection. In addition,
198 children with symptomatic HIV infection will be analyzed to provide an
assessment of cardiac dysautonomia in later stages of pediatric HIV
infection. Heart rate spectral analysis will be performed in the autonomic
physiology research unit at Children's Hospital, Boston on 2196 Holter
monitor recordings from these patients followed at the five P2C2 clinical
centers to capture noninvasively the time varying contributions of the
sympathetic and parasympathetic nervous system to the control of heart rate
throughout the course of a day. The spectral balance parameters and the
changing response of heart rate to the electrocardiogram-derived
respiratory signal will characterize the responsiveness of the sympathetic
and parasympathetic nervous system at rest and during the events of a
normal day. Autonomic function data will be electronically transmitted to
the P2C2 dam coordinating center at the Cleveland Clinic. Analysis of
these data at the Cleveland Clinic and the Harvard School of Public Health
with other factors collected in the P2C2 database (eg. infectious,
immunologic, growth, renal, neuroendocrine, pulmonary and cardiac) will
identify the interaction of these factors as to the risk they pose for
cardiac dysautonomia. Should significant cardiac dysautonomia be detected
then groups at particularly high risk will be identified as a cohort for
future trials to test the feasibility of using beta-adrenergic blockade to
alter the clinical significance of cardiac dysautonomia.
Effective start/end date6/12/925/31/95


  • National Institutes of Health: $62,357.00
  • National Institutes of Health


  • Medicine(all)


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