Myocardial Fibrosis, Inflammation Predict CV Outcome in HIV Patients

Aug 05, 2021
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Authors:
de Leuw P, Arendt CT, Haberl AE, et al.
Citation:
Myocardial Fibrosis and Inflammation by CMR Predict Cardiovascular Outcome in People Living With HIV. JACC Cardiovasc Imaging 2021;14:1548-1557.
Summary By:
Troy M LaBounty, MD, FACC

Quick Takes

  • Patients with HIV have increased risk of cardiovascular disease and heart failure.
  • Diffuse myocardial fibrosis and increased LV mass in patients with HIV on highly active antiretroviral therapy (HAART) on CMR imaging are associated with increased risk of adverse cardiovascular events.

Study Questions:

What is the prognostic value of adverse cardiac magnetic resonance (CMR) findings in patients with human immunodeficiency virus (HIV)?

Methods:

This observational prospective study evaluated patients with HIV on long-term highly active antiretroviral therapy (HAART) undergoing CMR imaging to evaluate ventricular volumes, T1 and T2 mapping, perfusion, and scar. The relationship between CMR findings and adverse outcomes (cardiovascular mortality, nonfatal acute coronary syndrome, appropriate device discharge, and heart failure admission) were evaluated.

Results:

There were 156 patients (62% male, median age 50 years) followed over a median of 13 months, with 24 events during this time (four deaths, one sudden cardiac death, two nonfatal acute coronary syndromes, one device discharge, 16 heart failure admissions). Patients with adverse events had higher left ventricular (LV) mass index (65 vs. 57 g/m2), higher native T1 and native T2 values, and greater incidence of myocardial late gadolinium enhancement (46 vs. 18%) and ischemic late gadolinium enhancement patterns (25 vs. 5%) (p < 0.05 for each). On multivariable analysis, increased native T1 was independently associated with adverse events (p = 0.001), and on another model, both increased native T1 (p = 0.007) and increased LV mass (p = 0.04) were independently associated with adverse events. Traditional risk factors were not significantly associated with adverse events.

Conclusions:

Diffuse myocardial fibrosis and increased LV mass in patients with HIV on HAART therapy are associated with increased risk of adverse cardiovascular events.

Perspective:

Patients with HIV experience an increased risk of cardiovascular disease and events. This may be related to a higher prevalence of traditional cardiovascular risk factors as well as the adverse metabolic effects of HAART. Further, some evidence suggests other contributing factors, including impaired cardiac function, increased mass, microvascular disease, and myocardial scarring. This study finds that increased native T1 and increased LV mass on CMR were independently associated with adverse cardiovascular events. These results suggest that CMR can identify patients at significantly increased risk of adverse events. Further, CMR may represent a useful monitoring tool to evaluate potential preventative approaches. Future multicenter studies to confirm these findings and evaluate the effectiveness of treatment strategies are warranted.

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, SCD/Ventricular Arrhythmias, Acute Heart Failure, Magnetic Resonance Imaging

Keywords: Acute Coronary Syndrome, Antiretroviral Therapy, Highly Active, Cardiomyopathies, Cicatrix, Contrast Media, Death, Sudden, Cardiac, Diagnostic Imaging, Gadolinium, Heart Failure, HIV Infections, HIV, Inflammation, Magnetic Resonance Imaging, Myocardium, Patient Discharge, Perfusion, Risk Factors, Secondary Prevention


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