IMPORTANCE HIV-associated cardiovascular disease is increasing in prevalence, but its mechanisms remain poorly understood.OBJECTIVE To systematically review data from advanced cardiovascular imaging studies evaluating computed tomographic coronary angiography, positron emission tomography (PET), and cardiac magnetic resonance (MR), in people living with HIV compared with uninfected individuals.DATA SOURCES Three databases and Google Scholar were searched for studies assessing cardiovascular pathology using computed tomographic coronary angiography, cardiac MR, PET, and HIV from inception to February 11, 2022.STUDY SELECTION Two reviewers selected original studies without any restrictions on design, date, or language, investigating HIV and cardiovascular pathology. DATA EXTRACTION AND SYNTHESISOne investigator extracted data checked by a second investigator. Prevalence ratios (PRs) and differences in inflammation among people living with HIV and uninfected individuals were qualitatively synthesized in terms of cardiovascular pathology. Study quality was assessed using the National Heart, Lung, and Blood Institute quality assessment tool for observational studies.MAIN OUTCOMES AND MEASURES Primary outcomes were computed tomographic coronary angiography-defined moderate to severe (Ն50%) coronary stenosis, cardiac MR-defined myocardial fibrosis identified by late gadolinium enhancement, and PET-defined vascular and myocardial target to background ratio. Prevalence of moderate to severe coronary disease, as well as myocardial fibrosis, and PRs compared with uninfected individuals were reported alongside difference in vascular target to background ratio.RESULTS Forty-five studies including 5218 people living with HIV (mean age, 48.5 years) and 2414 uninfected individuals (mean age, 49.1 years) were identified. Sixteen studies (n = 5107 participants) evaluated computed tomographic coronary angiography; 16 (n = 1698), cardiac MRs; 10 (n = 681), vascular PET scans; and 3 (n = 146), both computed tomographic coronary angiography and vascular PET scans. No studies originated from low-income countries. Regarding risk of bias, 22% were classified as low; 47% moderate; and 31% high. Prevalence of moderate to severe coronary disease among those with vs without HIV ranged from 0% to 52% and 0% to 27%, respectively, with PRs ranging from 0.33 (95% CI, 0.01-15.90) to 5.19 (95% CI,). Prevalence of myocardial fibrosis among those with vs without HIV ranged from 5% to 84% and 0% to 68%, respectively, with PRs ranging from 1.01 (95% CI, 0.85-1.21) to 17.35 (95% CI,. Differences in vascular target to background ratio among those with vs without HIV ranged from 0.06 (95% CI, 0.01-0.11) to 0.37 (95% CI, 0.02-0.72). CONCLUSIONS AND RELEVANCEIn this systematic review of studies of advanced cardiovascular imaging, the estimates of the associations between HIV and cardiovascular pathologies demonstrated large amounts of heterogeneity. The findings provide a summary of the available data but may not be representative of all individuals living...
Methods Fifty-one participants (37 non-obstructive HCM and 14 age, sex & BMI-matched controls) underwent 4D-flow CMR. Left ventricular (LV) end-diastolic volume was separated into four components: direct flow (blood transiting the ventricle within one cycle), retained inflow (blood entering the ventricle and retained for one cycle), delayed ejection flow (retained ventricular blood ejected during systole), and residual volume (ventricular blood retained for over two cycles). Results HCM patients demonstrated greater direct flow compared to controls (47.5±9% vs 39.4±6%, p=0.003), and reduction in other components. In contrast to controls, HCM exhibited a paradoxical reduction in stroke volume (r=-0.31) with increasing direct flow suggesting diminished cardiac reserve. This direct flow component proportion correlated with LV mass index (r=0.38), end-diastolic volume index (r=-0.42), and SCD risk (r=0.38). Neither LV ejection fraction, nor stroke volume correlated with markers of phenotypic severity. Conclusion HCM possesses a distinctive pattern of flow component distribution typified by direct flow-stroke volume decoupling, and in keeping with a diminished cardiac reserve. The correlation of direct flow proportion with phenotypic severity and SCD risk highlights its potential as a novel and sensitive haemodynamic measure of cardiovascular risk in patients.
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