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Results of comprehensive cardiovascular diagnostic work-up in HIV positive patients
Giulia Pontecorboli1, Filippo Lagi2, Mauro Bagli3
1Cardiovascular and Thoracic Department, Careggi University Hospital, Florence, Italy; Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy.
Insights
Cardiovascular disease (CVD) is common in HIV patients. A comprehensive diagnostic work-up detected CVD in nearly half of individuals, enabling early intervention and aggressive prevention strategies.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Cardiovascular disease (CVD) is a major cause of illness and death in people with HIV (PLWH).
- Accelerated atherosclerosis in PLWH is linked to inflammation, immune dysfunction, HIV medications, and other risk factors.
- With increased life expectancy, the burden of CVD in the HIV population is expected to grow.
Purpose of the Study:
- To assess the diagnostic value of a cardiovascular multimodality diagnostic approach in a contemporary HIV-infected cohort.
- To identify cardiovascular conditions in HIV patients using advanced imaging techniques.
- To evaluate the effectiveness of early detection and intervention for CVD in PLWH.
Main Methods:
- A cohort of 117 HIV-infected patients underwent a cardiovascular diagnostic work-up from November 2017 to October 2019.
- The work-up included clinical assessment, ECG, Transthoracic Echocardiogram (TTE), and advanced imaging (CCTA, stress-echo, CMR) when indicated.
- Statistical analysis identified risk factors associated with CVD and coronary artery disease (CAD).
Main Results:
- Fifty-two patients (45%) showed evidence of CVD, including Coronary Artery Disease (CAD) in 22 and non-ischemic heart disease (NIHD) in 47.
- Critical coronary stenosis was found in 8 patients with CAD, leading to interventions in 7.
- Hypertension and diabetes were significantly associated with CVD, while smoking and hypertension were linked to CAD.
Conclusions:
- A comprehensive cardiovascular diagnostic work-up effectively detects CVD in nearly half of HIV patients.
- Early detection allows for timely interventions and aggressive preventive treatment strategies.
- Multimodality imaging plays a crucial role in managing cardiovascular risk in the growing HIV population.
Abstract:
Cardiovascular disease (CVD) in the HIV population accounts for a large proportion of morbidity and mortality and, with the increased life expectancy, the burden of CVD is expected to rise. Inflammation, immune dysfunction, side effects of HIV medications, high prevalence of other risk factors are the likely pathogenic mechanisms for accelerated atherosclerosis. We aimed to evaluate the diagnostic yield of a cardiovascular multimodality diagnostic work-up in a contemporary cohort of HIV-infected patients. From November 2017 to October 2019, HIV infected patients were screened in a cardiovascular diagnostic work-up program including clinical history, physical examination, arterial blood pressure measurement, 12-lead ECG, and Transthoracic Echocardiogram (TTE). Advanced non-invasive cardiovascular imaging tests, like Coronary Computed Tomography Angiography (CCTA), stress-echocardiography, Cardiac Magnetic Resonance (CMR), were performed in patients with suspicion of chronic coronary syndrome (CCS) or non-ischemic heart disease (NIHD). 117 HIV-infected consecutive patients underwent this cardiovascular diagnostic work-up and were included in our study. Fifty-two patients (45%) had evidence of CVD. Of them, 22 presented Coronary Artery Disease (CAD), whereas 47 cases showed NIHD. In 17 cases both conditions were present. Among patients with CAD, 8 showed critical coronary stenosis; among them, 5 were treated with percutaneous coronary intervention, 2 with Aorto-Coronary By-Pass Grafting (CABG), and one with medical therapy. Hypertension and diabetes were significantly associated with the development of CVD (respectively p<0.001 and p< 0.05), while current smoking (p<0.02) and hypertension (p<0.007) were positively associated to CAD. A comprehensive cardiovascular diagnostic work-up including advanced multimodality diagnostic imaging modalities led to early detection of CVD in nearly half of an HIV population with immediate interventions required in 6.8% of them, and aggressive prevention treatment started in the remaining HIV patients.
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