Stress echocardiography may predict cardiac events in HIV

Pinzon O. Circ Cardiovasc Imaging. 2011; in press.

Issue: August 2011

More than one-quarter of a cohort of patients with HIV had an abnormal stress echocardiography, according to study results.

The aim of the study was to further investigate the prognostic value of stress echocardiography in 311 patients with HIV who were known or suspected to have coronary heart disease and who had undergone stress echocardiography (56% dobutamine). The rate of left ventricular ejection fraction was 54%.

An abnormal stress echocardiography was observed in 26% of patients. Results at 2.9 years follow-up indicated that there were 17 confirmed myocardial infarction and 14 cardiac deaths.

Patients stratified to the normal stress echocardiography risk group experienced an event rate of 0.6% per year vs. 11.8% in the abnormal group (P<.0001). Abnormal stress echocardiography independently predicted cardiac events (HR=28.2; 95% CI, 6.2-128.0), as did the presence of any ischemia (HR=3.4; 95% CI, 1.3-8.6).

Regression model analysis indicated that stress echocardiography was a stronger prognosticator than clinical, stress electrocardiographic and resting echocardiographic variables.

A 16-segment model 5-point scale was used to evaluate left ventricular wall motion. The researchers defined abnormal stress echocardiography by a fixed (infarction), biphasic or new (ischemia) wall motion abnormality on stress, according to the results. Endpoints of cardiac death or myocardial infarction were assessed during follow-up.

“[Stress echocardiography] can effectively risk stratify and prognosticate patients with HIV,” the researchers wrote. “The presence of ischemia and scar during [stress echocardiography] provides independent and incremental prognostic value over traditional variables.”

Disclosure: The researchers report no relevant financial disclosures.

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