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Mitral Annular and Coronary Artery Calcification Are Associated with Mortality in HIV-Infected Individuals

David C Lange1, David Glidden2, Eric A Secemsky3

  • 1Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.

Plos One
|July 2, 2015
PubMed

Insights

Coronary artery calcification (CAC) and mitral annular calcification (MAC) are associated with increased mortality in individuals with HIV. Adding MAC to CAC assessment improves risk prediction for death in this population.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Radiology

Background:

  • HIV infection is a known risk factor for cardiovascular disease (CVD).
  • Coronary artery calcification (CAC) and mitral annular calcification (MAC) are markers of cardiovascular risk.
  • Identifying individuals with HIV at higher risk for mortality is crucial.

Purpose of the Study:

  • To investigate the association between MAC, CAC, and mortality in HIV-infected individuals.
  • To determine if MAC and CAC can improve cardiovascular risk stratification in this population.

Main Methods:

  • 152 asymptomatic HIV-infected individuals underwent transthoracic echocardiography (TTE) and computed tomography (CT).
  • MAC was identified on TTE; CAC presence, score, and percentiles were determined by CT.
  • Mortality data was collected via the Social Security and National Death Indices (SSDI/NDI) over an 8-year median follow-up.

Main Results:

  • 25% of individuals had MAC, and 42% had CAC.
  • Subjects with CAC had significantly higher mortality compared to those without.
  • The predictive value for mortality improved from a Harrell's C-statistic of 0.66 for CAC alone to 0.75 when MAC was added (p=0.05).
  • MAC, prior CVD, age, and HIV viral load were independently associated with higher CAC percentiles.

Conclusions:

  • MAC and CAC are independently associated with increased mortality in HIV-infected individuals.
  • The presence of both MAC and CAC may enhance the identification of high-risk individuals.
  • These calcifications, alongside traditional risk factors and HIV viral load, are important indicators for mortality risk in HIV patients.
Abstract

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