Background: The present study performed a systematic review and meta-analysis of clinical trials using bisphosphonates for bone demineralization in human immunodeficiency virus (HIV) patients. Methods: A comprehensive literature search was performed from January 2004 to January 2020 considering the bone mineral density (BMD) of the lumbar spine (LS) as the main outcome. Out of 214 titles that met criteria, 9 studies fulfilled the selection criteria. Results: A total of 394 patients were identified, and they were allocated into 2 groups: the intervention group (200 patients), to whom a combination of alendronate or zoledronate with calcium and vitamin D was administered; and control group (194 patients), to whom only calcium and vitamin D was administered. Clinical profile and indicators of bone metabolism of the participants were evaluated regarding effect size, homogeneity, and consistency. No substantial heterogeneity between the groups was found for the baseline variables, and there was high consistency to the main outcome. The meta-analysis shows a significant difference in post-treatment BMD, favoring the intervention over the control treatment. The intervention improved LS density up to 0.227 g/cm², raising the average to the levels of general population. Adverse effects related to intervention were fever immediately after zoledronate administration and gastrointestinal complaints during alendronate usage. Other adverse effects were barely reported and poorly connected to intervention by studies’ authors, despite all of them have been successfully resolved. Conclusions This study provides evidence that BMD post-treatment is better in HIV patients who used bisphosphonates combined with calcium and vitamin D.

Background: Aortic regurgitation (AR) has an important impact on myocardial mechanics and recent studies have proved the value of global longitudinal strain (GLS) in the assessment of its severity and prognosis. Our purpose was to assess if the direct impact of the regurgitant jet on the myocardial wall could affect regional longitudinal strain. Methods: Eighty patients with chronic moderate/severe AR were retrospectively studied. Patients were considered to have a jet-related longitudinal strain reduction when the myocardial segments directly impacted by the jet had their longitudinal strain reduced by at least 30% compared to nonaffected segments. AR severity, left ventricular (LV) size and function were compared according to the presence/absence of this regional pattern. For those who underwent surgery, postoperative regional and global LV function was also analyzed. Results: A pattern of regional longitudinal strain impairment was identified in 43% of patients, with a regional reduction (in median) of 10 percentage points in absolute strain values in the segments impacted by the jet, compared to nonaffected segments. In the subgroup who underwent surgery, this pattern became attenuated after surgery.Patients with regional longitudinal strain impairment were less likely to improve GLS after surgery (10% vs. 38% improved GLS by at least 2.5%, P = 0.049). Conclusions To our knowledge, this study identifies for the first time, a link between the location of the impact of the regurgitant jet in AR and regional longitudinal strain impairment. The presence of this regional pattern might be associated with worse postoperative LV recovery.

Background: Aortic regurgitation (AR) has an important impact on myocardial mechanics and recent studies have proved the value of global longitudinal strain (GLS) in the assessment of its severity and prognosis. Our purpose was to assess if the direct impact of the regurgitant jet on the myocardial wall could affect regional longitudinal strain. Methods: Eighty patients with chronic moderate/severe AR were retrospectively studied. Patients were considered to have a jet-related longitudinal strain reduction when the myocardial segments directly impacted by the jet had their longitudinal strain reduced by at least 30% compared to nonaffected segments. AR severity, left ventricular (LV) size and function were compared according to the presence/absence of this regional pattern. For those who underwent surgery, postoperative regional and global LV function was also analyzed. Results: A pattern of regional longitudinal strain impairment was identified in 43% of patients, with a regional reduction (in median) of 10 percentage points in absolute strain values in the segments impacted by the jet, compared to nonaffected segments. In the subgroup who underwent surgery, this pattern became attenuated after surgery.Patients with regional longitudinal strain impairment were less likely to improve GLS after surgery (10% vs. 38% improved GLS by at least 2.5%, P = 0.049). Conclusions To our knowledge, this study identifies for the first time, a link between the location of the impact of the regurgitant jet in AR and regional longitudinal strain impairment. The presence of this regional pattern might be associated with worse postoperative LV recovery.

Background: Aortic regurgitation (AR) has an important impact on myocardial mechanics and recent studies have proved the value of global longitudinal strain (GLS) in the assessment of its severity and prognosis. Our purpose was to assess if the direct impact of the regurgitant jet on the myocardial wall could affect regional longitudinal strain. Methods: Eighty patients with chronic moderate/severe AR were retrospectively studied. Patients were considered to have a jet-related longitudinal strain reduction when the myocardial segments directly impacted by the jet had their longitudinal strain reduced by at least 30% compared to nonaffected segments. AR severity, left ventricular (LV) size and function were compared according to the presence/absence of this regional pattern. For those who underwent surgery, postoperative regional and global LV function was also analyzed. Results: A pattern of regional longitudinal strain impairment was identified in 43% of patients, with a regional reduction (in median) of 10 percentage points in absolute strain values in the segments impacted by the jet, compared to nonaffected segments. In the subgroup who underwent surgery, this pattern became attenuated after surgery.Patients with regional longitudinal strain impairment were less likely to improve GLS after surgery (10% vs. 38% improved GLS by at least 2.5%, P = 0.049). Conclusions To our knowledge, this study identifies for the first time, a link between the location of the impact of the regurgitant jet in AR and regional longitudinal strain impairment. The presence of this regional pattern might be associated with worse postoperative LV recovery.