Key result
Asymptomatic patients with chronic HIV infection exhibited a significantly higher prevalence of myocardial fibrosis on cardiac magnetic resonance compared to healthy controls (82.1% vs 27.3%; P<0.001).
Why the study?
Does comprehensive CMR reveal subclinical cardiovascular involvement in asymptomatic HIV-infected patients compared to healthy controls?
Observational (n=50)
Does comprehensive CMR reveal subclinical cardiovascular involvement in asymptomatic HIV-infected patients compared to healthy controls?
Absolute Event Rate: 82.1% vs 27.3%
p-value: p=<0.001
Comprehensive CMR reveals a high burden of subclinical cardiovascular disease, including myocardial inflammation and fibrosis, in asymptomatic HIV-infected patients on antiretroviral therapy.
Supports subclinical fibrosis screening research in asymptomatic HIV; hypothesis-generating and should not yet change practice.
BACKGROUND: People living with chronic HIV infection are at an increased risk for cardiovascular disease. With this study, we aimed to determine the extent of cardiovascular involvement in asymptomatic HIV-infected patients by a comprehensive cardiac magnetic resonance (CMR) approach. METHODS AND RESULTS: Asymptomatic patients with chronic HIV infection undergoing combination antiretroviral therapy (n=28) and control subjects (n=22) underwent CMR. HIV-infected patients were successfully controlled for the disease with a consistent plasma viremia of <200 copies/mL (mean CD4(+)-cell count, 475.1±307.9 cells/μL). CMR protocol allowed for the determination of cardiac function, myocardial inflammation, myocardial fibrosis, aortic stiffness, and pericardial fat volume. When compared with healthy controls, HIV-infected patients showed alterations in left ventricular function as demonstrated by a lower ejection fraction (60.9±7.1% versus 65.2±5.5%; P=0.023) and lower global peak systolic longitudinal and circumferential strain values (longitudinal strain, -17.7±3.4% versus -20.2±3.2%, circumferential strain, -21.2±4.6% versus -24.7±5.1%; P<0.001, respectively). CMR parameters indicating myocardial inflammation were elevated in HIV-infected patients (native T1 relaxation times, 1128.3±53.4 ms versus 1086.5±54.5 ms; P=0.009; relative T2 signal intensity ratio, 1.6±0.3 versus 1.4±0.3; P=0.046; early gadolinium enhancement ratio, 3.1±1.2 versus 2.1±0.6; P=0.003). Myocardial fibrosis, predominantly at the subepicardium of the midventricular and basal inferolateral wall, was prevalent in 82.1% of HIV-infected patients, but only in 27.3% of healthy controls (P<0.001). CONCLUSIONS: Comprehensive CMR revealed a high burden of cardiovascular disease in asymptomatic HIV-infected patients. Subclinical myocardial inflammation as detected by CMR may be a potential precursor of the increased cardiovascular morbidity and mortality observed in patients with chronic HIV infection.
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Luetkens et al. (2016) conducted an observational in Asymptomatic chronic HIV infection (n=50). Chronic HIV infection vs. Healthy controls was evaluated on Prevalence of myocardial fibrosis (p=<0.001). Asymptomatic patients with chronic HIV infection exhibited a significantly higher prevalence of myocardial fibrosis on cardiac magnetic resonance compared to healthy controls (82.1% vs 27.3%; P<0.001).
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