Related Experiment Video
Updated: Nov 19, 2025
Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Exercise ECG for coronary artery disease screening in people living with HIV
Camilla Muccini1, Laura Galli2, Andrea Poli2
1Faculty of Medicine and Surgery, Vita-Salute San Raffaele University.
Insights
ECG stress testing effectively detects coronary artery disease in people with HIV and cardiovascular risk factors. Abnormal carotid Doppler ultrasound results combined with a high atherosclerotic cardiovascular disease risk score indicate increased risk for inducible myocardial ischemia.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Coronary artery disease (CAD) is a major cause of mortality in people living with HIV (PLWH).
- PLWH often present with multiple cardiovascular risk factors, increasing their susceptibility to CAD.
- Early detection of CAD in this population is crucial for effective management and improved outcomes.
Purpose of the Study:
- To evaluate the utility of ECG stress testing (EST) for identifying CAD in PLWH with cardiovascular risk factors.
- To assess the correlation between EST findings, carotid color-Doppler ultrasonography (CDU) results, and atherosclerotic cardiovascular disease (ASCVD) risk scores in PLWH.
- To determine the prevalence of inducible myocardial ischemia (IMI) in this cohort.
Main Methods:
- The CORDIS study enrolled 309 PLWH meeting specific age and HIV RNA criteria, and possessing at least one cardiovascular risk factor.
- Participants underwent EST and bilateral carotid CDU. Patients with prior CAD diagnosis or cardiac symptoms were excluded.
- Logistic regression analysis was used to identify predictors of IMI, with results analyzed based on CDU findings and ASCVD risk scores.
Main Results:
- The prevalence of IMI detected by EST was 7.4%.
- No IMI was observed in individuals with normal CDU results.
- In individuals with abnormal CDU, IMI prevalence increased significantly with higher ASCVD risk scores (P for trend: 0.02).
- Multivariate analysis confirmed that ASCVD risk score was independently associated with both EST-suggestive IMI and confirmed IMI.
Conclusions:
- ECG stress testing is a valuable tool for screening CAD in PLWH.
- An abnormal CDU and a high ASCVD risk score are indicators for considering EST in PLWH without cardiac symptoms.
- These findings support a targeted screening approach for CAD in at-risk PLWH.
Background:
Coronary artery disease (CAD) is one of the leading causes of death among people living with HIV (PLWH). We evaluated ECG stress testing (EST) for detecting CAD in PLWH with multiple cardiovascular risk factors.
Methods:
CORDIS was a cross-sectional study conducted in PLWH. Inclusion criteria were men at least 50 years or postmenopausal women, HIV-1 RNA less than 50 copies/ml and at least one of the following cardiovascular risk factor: familial history of CAD, smoking, hypertension, hypercholesterolemia or diabetes. Patients with a previous diagnosis of CAD or with cardiac symptoms were excluded. EST was performed concomitantly with bilateral carotid color-Doppler ultrasonography (CDU) and evaluated by a cardiologist. Results were described by median (interquartile range) or frequency (%). Logistic regression was applied to evaluate predictive factors of inducible myocardial ischemia (IMI).
Results:
EST and CDU were performed in 309 individuals; IMI prevalence was 7.4% [95% confidence interval (CI): 5.0-11.0%]. Among patients with a normal CDU, no cases of IMI were observed. In people with abnormal CDU, IMI prevalence increased accordingly with the atherosclerotic cardiovascular disease (ASCVD) risk score: 10.2%, 16.9%, 19.7%, 27.8% and 30.4% among individuals with ASCVD score 7.5% or less, more than 7.5%, more than 10%, more than 15% and more than 20%, respectively (P for trend: 0.02). At multivariate analysis, ASCVD risk score was associated with EST suggestive of IMI (adjusted odds ratio for 1% increase = 1.08; 95% CI: 1.02-1.13, P = 0.005) and with confirmed IMI (adjusted odds ratio for 1% increase = 1.11; 95% CI: 1.04-1.19, P = 0.003).
Conclusion:
Prevalence of IMI was 7.4% in the CORDIS study. We suggest EST as first-line screening for CAD in PLWH without cardiac symptoms, with an abnormal CDU and a high ASCVD risk score.
More Related Videos
05:03Patient Directed Recording of a Bipolar Three-Lead Electrocardiogram using a Smartwatch with ECG Function
Published on: December 11, 2019
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
Related Concept Videos
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...
01:26Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
01:26Coronary Artery Disease IV: Preventive Measures
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...
01:30Coronary Artery Disease I: Introduction