Use of cardiac CT angiography imaging in an epidemiology study - the Methodology of the Multicenter AIDS Cohort Study cardiovascular disease substudy

Hacıoğlu, Yalçın; Gupta, Mohit; Choi, Tae Young; George, Richard Т. De; Deible, Christopher; Jacobson, Lisa P.; Witt, Mallory D.; Palella, Frank J.; Post, Wendy S.; Budoff, Matthew J.

doi:10.5152/akd.2013.065

Cited by 33 publications

(42 citation statements)

References 31 publications

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“…18, 24 Inclusion criteria for MACS-CVD were being an active MACS participant (with oversampling of HIV-infected men), age 40–70 years, weight <300 lbs., and no prior history of cardiac surgery or percutaneous coronary intervention since these procedures would interfere with the measurement of coronary atherosclerosis. Exclusion criteria for CCTA measurement included atrial fibrillation, chronic kidney disease [estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m 2 within 30 days of the CT) or a history of intravenous contrast allergy.…”

Section: Methodsmentioning

confidence: 99%

“…18, 24 Briefly, participants received a beta-blocker or calcium channel blocker if needed for heart rate control, followed by sublingual nitroglycerin before administration of IV contrast unless contraindicated. CCTA was performed with electrocardiogram-triggered protocols and a median radiation dose of 1.9 mSv (interquartile range, 1.7–2.7 mSv).…”

Section: Methodsmentioning

confidence: 99%

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Frailty and subclinical coronary atherosclerosis: The Multicenter AIDS Cohort Study (MACS)

et al. 2017

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Background and aims Frailty and cardiovascular disease share many risk factors. We evaluated whether frailty is independently associated with subclinical coronary atherosclerosis and whether any relationships differ by HIV-serostatus. Methods We studied 976 [62% HIV-infected] male participants of the Multicenter AIDS Cohort Study who underwent assessment of frailty and non-contrast cardiac CT scanning; of these, 747 men also underwent coronary CT angiography (CCTA). Frailty was defined as having ≥3 of 5 of the following: weakness, slowness, weight loss, exhaustion, and low physical activity. Coronary artery calcium (CAC) was assessed by non-contrast CT, and total plaque score (TPS), mixed plaque score (MPS), and non-calcified plaque score (NCPS) by CCTA. Multivariable-adjusted regression was used to assess the cross-sectional associations between frailty and subclinical coronary atherosclerosis. Results Mean (SD) age of participants was 54 (7) years; 31% were black. Frailty existed in 7.5% and 14.3% of HIV-uninfected and HIV-infected men, respectively. After adjustment for demographics, frailty was significantly associated with prevalence of any CAC (CAC>0), any plaque (TPS>0), and mixed plaque (MPS>0) in HIV-uninfected but not in HIV-infected men (p-interaction_HIV<0.05 for all). Among HIV-uninfected men, after adjustment for cardiovascular risk factors, frailty was significantly associated only with CAC>0 [Prevalence Ratio 1.27 (95%CI 1.02, 1.59)] and TPS>0 [1.19 (1.06, 1.35)]. No association was found for NCPS. Conclusions Frailty was independently associated with subclinical coronary atherosclerosis among HIV-uninfected men, but not among HIV-infected men. Further work is needed to ascertain mechanisms underlying these differences and whether interventions that improve frailty (i.e. strength training) can improve cardiovascular outcomes.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Frailty and subclinical coronary atherosclerosis: The Multicenter AIDS Cohort Study (MACS)

et al. 2017

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“…Details about CT scanning procedures and analysis have been previously described [19]. Briefly, non-contrast CT scans were analyzed for CAC using the Agatston method [20].…”

Section: Methodsmentioning

confidence: 99%

HIV and coronary arterial remodeling from the Multicenter AIDS Cohort Study (MACS)

Miller¹,

Haberlen²,

Metkus³

et al. 2015

Atherosclerosis

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Objective Positive remodeling (PR), a coronary artery characteristic associated with risk for myocardial infarction (MI), may be more prevalent in HIV-infected (HIV+) people. We evaluated the prevalence of PR using coronary CT angiography (CCTA) in HIV+ and HIV-uninfected (HIV−) men. Methods/Results Men enrolled in the Multicenter AIDS Cohort Study underwent CCTA if they were 40–70 years, had normal kidney function and no history of coronary revascularization. Multivariable logistic regression models were used to estimate the odds ratio (OR) of PR by HIV serostatus, adjusting for demographics and coronary artery disease (CAD) risk factors. Analysis of PR among atherosclerotic segments further adjusted for plaque type and stenosis. The prevalence of PR was 8.4% versus 12.1% (p=0.10) for HIV− and HIV+ men, respectively. After demographic adjustment, HIV+ men had twice the odds of PR [OR 2.01(95% CI 1.20–3.38)], which persisted after CAD risk factor adjustment [1.76(1.00–3.10)]. Higher systolic blood pressure, total cholesterol, diabetes medication use, older age, segment number with plaque present, mixed and non-calcified plaque, and stenosis>50%, were associated with increased odds of PR, while higher HDL cholesterol, higher nadir CD4 count, and black race were associated with lower PR odds. Among atherosclerotic segments, the association between HIV infection and PR persisted, but was not statistically significantly. Conclusion HIV+ men have more positively remodeled arterial segments, which may be due to more coronary segments with atherosclerosis or HIV-related immunosuppression. Further studies are needed to evaluate whether PR contributes to higher rates of MI in HIV+ individuals.

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“…[20] Non-contrast cardiac CT scans and a single imaging slice of the abdomen at the level of the fourth lumbar vertebra were performed to measure CAC and adipose tissue volumes, including epicardial adipose tissue volume (EAT), pericardial adipose tissue volume (PAT), intrathoracic adipose tissue volume (IAT), and abdominal visceral fat volume (AVF).…”

Section: Methodsmentioning

confidence: 99%

Epicardial fat is associated with duration of antiretroviral therapy and coronary atherosclerosis

Brener

Ketlogetswe

Budoff

et al. 2014

Aids

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Objective Cytokines released by epicardial fat are implicated in the pathogenesis of atherosclerosis. HIV infection and anti-retroviral therapy have been associated with changes in body fat distribution and coronary artery disease. We sought to determine if HIV infection is associated with greater epicardial fat and if epicardial fat is associated with subclinical coronary atherosclerosis. Design We studied 579 HIV-infected and 353 HIV-uninfected men age 40 to 70 years with non-contrast computed tomography (CT) to measure epicardial adipose tissue volume (EAT) and coronary artery calcium (CAC). Total plaque score (TPS), and plaque subtypes (non-calcified, calcified and mixed) were measured by coronary CT angiography in 706 men. Methods We evaluated the association between EAT and HIV serostatus, and the association of EAT with subclinical atherosclerosis, adjusting for age, race and serostatus and with additional cardiovascular (CV) risk factors and tested for modifying effects of HIV serostatus. Results HIV-infected men had greater EAT than HIV-uninfected men (p=0.001). EAT was positively associated with duration of antiretroviral therapy (p=0.02), specifically AZT (p<0.05). EAT was associated with presence of any coronary artery plaque (p=0.006) and non-calcified plaque (p=0.001), adjusting for age, race, serostatus and CV risk factors. Among men with CAC, EAT was associated with CAC extent (p=0.006). HIV serostatus did not modify associations between EAT and either CAC extent or presence of plaque. Conclusions Greater epicardial fat volume in HIV-infected men and its association with coronary plaque and antiretroviral therapy duration suggest potential mechanisms that might lead to increased risk for cardiovascular disease in HIV.

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Use of cardiac CT angiography imaging in an epidemiology study - the Methodology of the Multicenter AIDS Cohort Study cardiovascular disease substudy

Cited by 33 publications

References 31 publications

Frailty and subclinical coronary atherosclerosis: The Multicenter AIDS Cohort Study (MACS)

Frailty and subclinical coronary atherosclerosis: The Multicenter AIDS Cohort Study (MACS)

HIV and coronary arterial remodeling from the Multicenter AIDS Cohort Study (MACS)

Epicardial fat is associated with duration of antiretroviral therapy and coronary atherosclerosis

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