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Should HIV-infected patients be screened for silent myocardial ischaemia using gated myocardial perfusion SPECT?
Denis Mariano-Goulart1, Jean-Marc Jacquet, Nicolas Molinari
1Department of Nuclear Medicine, Montpellier University Hospital, Montpellier, France. d-mariano_goulart@chu-montpellier.fr
Insights
Screening for silent myocardial ischemia (SMI) using myocardial SPECT in HIV-infected men over 52 with multiple cardiovascular risk factors (CRFs) is highly effective. This approach identifies a higher prevalence of SMI, prompting further investigation in this vulnerable population.
Area of Science:
- Cardiology
- Infectious Diseases
- Nuclear Medicine
Background:
- HIV infection is associated with increased cardiovascular risk factors (CRFs).
- Chronic HIV infection and its treatments can lead to silent myocardial ischemia (SMI).
- There is a need to identify effective screening methods for SMI in asymptomatic HIV patients.
Purpose of the Study:
- To evaluate the utility of myocardial SPECT for screening asymptomatic HIV-infected patients for coronary artery disease.
- To determine the prevalence of SMI in HIV-infected individuals with normal cardiovascular examinations.
Main Methods:
- Myocardial SPECT was performed on 94 HIV-infected patients with normal clinical cardiovascular exams.
- Data collected included anthropomorphic parameters, CRFs, inflammatory markers, HIV status, and treatment.
- Univariate and multivariate analyses were used to identify associations with SMI.
Main Results:
- Coronary artery disease was detected in 9.6% of patients; 8 had ischemia.
- SMI was significantly associated with the number of CRFs and the combination of gender and age.
- All positive myocardial SPECT scans were in men >52 years with ≥2 CRFs, showing a 19.2% prevalence in this subgroup.
Conclusions:
- Myocardial SPECT is effective in screening for SMI in specific HIV-infected patient subgroups.
- Male HIV-infected patients >52 years with ≥2 CRFs have a significantly higher likelihood of SMI.
- These findings support systematic SMI screening with myocardial SPECT in this high-risk HIV population.
Purpose:
A higher prevalence of cardiovascular risk factors (CRFs) in HIV-infected patients, together with chronic infection and treatments, has resulted in an increased risk of silent myocardial ischaemia (SMI). The objective of this study was to evaluate whether myocardial SPECT should be used for screening HIV-infected patients with no clinical symptoms of coronary artery disease.
Methods:
The prevalence of SMI detected by myocardial SPECT was determined in 94 HIV-infected patients with a normal clinical cardiovascular examination in relation to anthropomorphic parameters, CRFs, inflammatory and HIV infection status, and treatment.
Results:
Coronary artery disease was detected in nine patients (eight with ischaemia, one with myocardial infarction), corresponding to 9.6 % positivity. All but two of the scintigraphic diagnoses of ischaemia were confirmed by coronarography. Univariate analysis revealed that the overall number of CRFs and the combination of gender and age were associated with a diagnosis of SMI (p < 0.05). According to multivariate analysis, the only independent parameter significantly associated with the scintigraphic diagnosis of SMI was the combination of gender and age (p = 0.01). All the positive myocardial SPECT scans were in men older than 52 years with at least two other CRFs. In this subpopulation of 47 patients, the prevalence of SMI detected by myocardial SPECT reached 19.2 %.
Conclusion:
In male HIV-infected patients older than 52 years and with at least two other CRFs, screening for SMI using myocardial SPECT was about four times more likely to be positive than in the general population. This may motivate physicians to advise these patients to undergo more systematic screening for SMI using this technique.
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