Cardiac Magnetic Resonance Reveals Signs of Subclinical Myocardial Inflammation in Asymptomatic HIV-Infected Patients

Luetkens, Julian A.; Doerner, Jonas; Schwarze‐Zander, Carolynne; Wasmuth, Jan‐Christian; Boesecke, Christoph; Sprinkart, Alois M.; Schmeel, Frederic Carsten; Homsi, Rami; Gieseke, J; Schild, Hans H.; Rockstroh, Jürgen K.; Naehle, Claas P.

doi:10.1161/circimaging.115.004091

Cited by 87 publications

(79 citation statements)

References 35 publications

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“…Additionally, other factors not addressed in this study may have played a role. Specifically, among PHIV, the increased CV risk is, in part, independent of traditional CV risk factors and is probably related to a persistent and heightened state of inflammation (28–30). Inflammation is associated with worse outcomes in HF and CV disease, and the persistent inflammation in HIV may not be addressed using ART alone.…”

Section: Discussionmentioning

confidence: 99%

Protease Inhibitors and Cardiovascular Outcomes in Patients With HIV and Heart Failure

Alvi

Neilan

Tariq

et al. 2018

Journal of the American College of Cardiology

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BACKGROUND Incident heart failure (HF) is increased in persons with human immunodeficiency virus (PHIV). Protease inhibitors (PIs) are associated with adverse cardiac remodeling and vascular events; however, there are no data on the use of PIs in PHIV with HF. OBJECTIVES This study sought to compare characteristics, cardiac structure, and outcomes in PHIV with HF who were receiving PI-based versus non-PI (NPI) therapy. METHODS This was a retrospective single-center study of all 394 antiretroviral therapy–treated PHIV who were hospitalized with HF in 2011, stratified by PI and NPI. The primary outcome was cardiovascular (CV) mortality, and the secondary outcome was 30-day HF readmission rate. RESULTS Of the 394 PHIV with HF (47% female, mean age 60 ± 9.5 years, CD4 count 292 ± 206 cells/mm3),145 (37%) were prescribed a PI, whereas 249 (63%) were prescribed NPI regimens. All PI-based antiretroviral therapy contained boosted-dose ritonavir. PHIV who were receiving a PI had higher rates of hyperlipidemia, diabetes mellitus, and coronary artery disease (CAD); higher pulmonary artery systolic pressure (PASP); and lower left ventricular ejection fraction. In follow-up, PI use was associated with increased CV mortality (35% vs. 17%; p < 0.001) and 30-day HF readmission (68% vs. 34%; p < 0.001), effects seen in all HF types. Predictors of CV mortality included PI use, CAD, PASP, and immunosuppression. Overall, PIs were associated with a 2-fold increased risk of CV mortality. CONCLUSIONS PI-based regimens in PHIV with HF are associated with dyslipidemia, diabetes, CAD, a lower left ventricular ejection fraction, and a higher PASP. In follow-up, PHIV with HF who are receiving a PI have increased CV mortality and 30-day HF readmission.

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Section: Discussionmentioning

confidence: 99%

Protease Inhibitors and Cardiovascular Outcomes in Patients With HIV and Heart Failure

Alvi

Neilan

Tariq

et al. 2018

Journal of the American College of Cardiology

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“…Instead, as reported previously in multiple CMR studies, the initial diagnosis of acute myocarditis was mainly made based on clinical parameters [6,7]. Alterations of myocardial strain parameters are non-specific and can be detected in many acute and chronic cardiac diseases and conditions (e. g. in patients longstanding chronic disease [34] or significant coronary artery disease [35]). Due to the retrospective study design, patients were investigated at three different CMR scanners, which might have influenced some quantitative measurements (e. g. myocardial strain analysis).…”

Section: Limitationsmentioning

confidence: 99%

Left and right ventricular strain in the course of acute myocarditis: a cardiovascular magnetic resonance study

Luetkens

Petry

Kuetting

et al. 2018

Fortschr Röntgenstr

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“…Myocardial fibrosis may play a key role; it is a key pathophysiological driver for the development of cardiac arrhythmias, and both the presence and the extent of myocardial fibrosis are predictors of ventricular arrhythmias 15, 18, 19, 20. At baseline, PHIV without HF have both an increase in the presence and extent of myocardial fibrosis 21, 22. For example, Holloway and colleagues detected late gadolinium enhancement, replacement myocardial fibrosis on MRI, in 76% of PHIV compared with 13% of controls 21.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Predictors, and Outcomes of Implantable Cardioverter‐Defibrillator Discharge Among People Living With HIV

Alvi

Neilan

Tariq

et al. 2018

JAHA

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BackgroundPeople living with HIV (PHIV) are at an increased risk for sudden cardiac death, and implantable cardioverter‐defibrillators (ICDs) prevent SCD. There are no data on the incidence, predictors, and effects of ICD therapies among PHIV.Methods and ResultsWe compared ICD discharge rates between 59 PHIV and 267 uninfected controls. For PHIV, we tested the association of traditional cardiovascular risk factors and HIV‐specific parameters with an ICD discharge and then tested whether an ICD discharge among PHIV was associated with cardiovascular mortality or an admission for heart failure. The indication for ICD insertion was similar among groups. Compared with controls, PHIV with an ICD were more likely to have coronary artery disease and to use cocaine. In follow‐up, PHIV had a higher ICD discharge rate (39% versus 20%; P=0.001; median follow‐up period, 19 months). Among PHIV, cocaine use, coronary artery disease, QRS duration, and higher New York Heart Association class were associated with an ICD discharge. An ICD discharge had a prognostic effect, with a subsequent 1.7‐fold increase in heart failure admission and a 2‐fold increase in cardiovascular mortality, an effect consistent across racial/ethnic and sex categories.Conclusions ICD discharge rates are higher among PHIV compared with uninfected controls. Among PHIV, cocaine use and New York Heart Association class are associated with increased ICD discharge, and an ICD discharge is associated with a subsequent increase in admission for heart failure and cardiovascular mortality.

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Cardiac Magnetic Resonance Reveals Signs of Subclinical Myocardial Inflammation in Asymptomatic HIV-Infected Patients

Cited by 87 publications

References 35 publications

Protease Inhibitors and Cardiovascular Outcomes in Patients With HIV and Heart Failure

Protease Inhibitors and Cardiovascular Outcomes in Patients With HIV and Heart Failure

Left and right ventricular strain in the course of acute myocarditis: a cardiovascular magnetic resonance study

Incidence, Predictors, and Outcomes of Implantable Cardioverter‐Defibrillator Discharge Among People Living With HIV

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