Human immunodeficiency virus-infected subjects have no altered myocardial perfusion

Should HIV-infected patients be screened for silent myocardial ischaemia using gated myocardial perfusion SPECT?

“…To our knowledge, all but one of the myocardial scintigraphic studies in HIV-infected patients have investigated only endothelial or vasomotor function [37,38] or have investigated a single clinical case [39]. The only clinical study of myocardial perfusion using gated SPECT in HIVinfected patients under highly active antiretroviral therapy is that of Catzin-Kuhlmann et al and the finding was negative [23]. In that study no difference was found in SMI prevalence in HIV-infected patients compared with an age-and gender-matched group of infection-free subjects, with the prevalence in HIV-infected patients (4.8 %) being similar to that generally found in studies involving healthy subjects.…”

“…Gated single-photon computed emission tomography myocardial perfusion scintigraphy (SPECT) is more sensitive than stress ECG for the detection of CAD, is useful and cost-effective for identifying patients in need of coronary angiography, and provides independent and incremental information for predicting cardiac events [21,22]. However, this modality has been used in only one study, which showed no evidence of an increased risk for SMI in young HIV-infected patients receiving highly active antiretroviral therapy and showing a high prevalence of dyslipidaemia and an alteration in circulating markers of inflammation [23].…”

The role of multimodality imaging in HIV-related heart disease

“…20 Myocardial perfusion imaging (MPI) with singlephoton emission computerized tomography (SPECT) and positron emission tomography (PET) has high sensitivity and specificity in diagnosing CAD in the HIV cohorts. 21,22 SPECT, which is more commonly available in comparison to PET, is one of the initial tests for evaluating HIV patients with symptoms suggestive of CAD. PET allows evaluation of myocardial perfusion, assessment of quantitative myocardial blood flow (MBF), and coronary flow reserve (CFR).…”

The role of radionuclide myocardial perfusion imaging for asymptomatic individuals

“…A single study examined the use of RMPI in asymptomatic HIV-infected subjects and did not demonstrate an increase in the prevalence of abnormal myocardial perfusion. 63 Thus, no data is presently available to support the use of RMPI for detection of occult CAD in asymptomatic HIV-infected patients, although certain anti-HIV medications may increase the risk of cardiac events.…”