Reply: A comprehensive evaluation of left atrial performance using volumetric analysis, strain, and strain rate imaging.

into the pathogenesis of heart disease in patients treated for HIV infection. Lipodystrophy can indeed lead to ectopic spillover of triglyceride into nonadipose tissues—including the myocardium—and has previously been associated with adverse LV remodeling (2). Furthermore, that HAART exposure also predicted myocardial triglyceride content and LV dysfunction provides further insight into the pathogenesis of heart disease in HIV(þ) patients. For example, HAART has been associated with lipodystrophy, hyperlipidemia, and hyperglycemia (4) and may be directly cardiotoxic (5). Thus, whereas HAART has significantly reduced HIVrelated morbidity and mortality, we speculate that HAART may also contribute to the cardiovascular decline in HIV(þ) patients. Future studies are warranted to further investigate these findings.