HIV-Related Myocardial Vulnerability to Infarction and CAD

Study Questions:

What is the impact of human immunodeficiency virus infection (HIV+) on myocardial scar associated with myocardial infarction (MI) and coronary artery disease (CAD)?

Methods:

The investigators created an electronic cohort (“HIVE-4CVD”) of HIV+ persons and uninfected controls (matched 1:2 on demographics and cardiovascular disease [CVD] test modality) who underwent CVD testing at their institution between 2000 and 2015. The co-primary analyses compared % myocardium with scar and % myocardium with scar/number of coronary arteries with ≥50% diameter stenosis for HIV+ patients versus uninfected controls. Two expert readers blinded to HIV status estimated myocardial scar burden based on extent of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) using the point system recommended by 2013 Society of Cardiovascular Magnetic Resonance guidelines (0-4 for each segment corresponding to LGE affecting 0-25%, 26-50%, 51-75%, or >75% of each myocardial segment).

Results:

The two comparison groups had nearly identical CAD burden (2.25 coronary arteries with ≥50% stenosis for HIV+, 2.27 for uninfected patients), CAD distribution, and indications for angiography and CMR. Despite these similarities, HIV+ patients had twice the extent of myocardial scar compared with uninfected controls (22.8% vs. 11.3%; p = 0.01; see Figure 1 in this article). After accounting for CAD extent by dividing total myocardial scar burden by number of arteries with ≥50% stenosis, this difference between HIV+ patients and uninfected controls remained highly significant (10.7% vs. 5.0%; p < 0.001). Parallel analyses of only patients with electronic health record–documented, adjudicated MI yielded similar results.

Conclusions:

The authors concluded that HIV+ patients had twice the extent of myocardial scar compared with uninfected controls.

Perspective:

This study reports that despite nearly identical CAD burden, HIV+ patients had twice the extent of myocardial scar compared with uninfected controls. This finding that HIV+ persons have more extensive myocardial scar than uninfected persons in the setting of CAD and MI warrants further research. If these findings are confirmed and HIV+ persons have larger areas of necrosis and scar following MI, this may help inform HIV-related mechanisms implicated in heart failure and sudden cardiac death, and may help develop novel targeted therapies.

Clinical Topics: Acute Coronary Syndromes, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Acute Heart Failure, Interventions and ACS, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Acute Coronary Syndrome, Angiography, Constriction, Pathologic, Coronary Artery Disease, Diagnostic Imaging, Electronic Health Records, Gadolinium, Heart Failure, HIV Infections, Infarction, Magnetic Resonance Spectroscopy, Myocardial Infarction, Myocardium, Primary Prevention


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