Myocardial fibrosis, LV remodeling may predict CV events in people living with HIV
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For patients living with HIV on long-term highly active antiretroviral therapy, diffuse myocardial fibrosis and left ventricular remodeling may be predictive of adverse CV events, according to data published in JACC: Cardiovascular Imaging.
“These findings together indicate a complex underlying pathophysiology in the development of heart disease in people living with HIV, with a prominent role of diffuse myocardial interstitial fibrosis in driving the clinical outcome,” Philipp de Leuw, MD, specialist in internal medicine and infectious diseases at Infektiologikum Frankfurt in Germany, and colleagues wrote.
For the prospective study, researchers included 156 consecutive participants living with HIV on long-term highly active antiretroviral therapy (median age, 50 years; 62% men) who underwent cardiac MRI. Measurements included myocardial volumes and function, T1 and T2 mapping, perfusion and scar. The primary endpoint was first single CV event per patient, which encompassed CV mortality, nonfatal ACS, an appropriate device discharge or a documented HF hospitalization. Median follow-up was 13 months.
Researchers reported that patients living with HIV who experienced a first event had higher native T1 (median 1,149 ms vs. 1,110 ms), native T2 (40 ms vs. 37 ms); LV mass (65 g/m2 vs. 57 g/m2) and N-terminal pro-B-type natriuretic peptide level (109 pg/L vs. 48 pg/L; P for all < .05) compared with those who did not experience a CV event during follow-up.
Additionally, participants who experienced a first CV event had lower LV ejection fraction compared with those who did not (median LVEF, 55% vs. 58%; P = .052).
According to the study, native T1 was independently predictive of adverse CV events (chi-square test, 15.9; P < .001; HR = 1.2; 95% CI, 1.08-1.33; P .001), followed by a model that also included LV mass (chi-square test, 17.1; P < .001).
The researchers reported that traditional CV risk scores were not predictive of first adverse CV events among patients living with HIV on long-term highly active antiretroviral therapy.
“Our findings may support the development of novel personalized approaches to cardioprotection, including screening and anti-remodeling treatment in pre-HF, to reduce the HF burden in people living with HIV receiving long-term highly active antiretroviral therapy,” the researchers wrote.
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