Myocardial Fibrosis and Inflammation by CMR Predict Cardiovascular Outcome in People Living With HIV |
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Institution: | 1. HIV Center, Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany;2. Infektiologikum, Frankfurt am Main, Germany;3. Institute of Experimental and Translational Cardiac Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany;4. Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany;5. Cardiology Department, Enrique Baltodano Briceño Hospital, Liberia, Costa Rica;6. Department of Cardiology, School of Medicine and Psychology, Sapienza University of Rome, Rome, Italy;7. Department of Radiology, XiangYa Hospital, Central South University, Changsha, Hunan, China;8. Department of Cardiology, Universiti Teknologi MARA (UiTM), Sg. Buloh, Malaysia;9. Department of Cardiology, University Hospital Warsaw, Warsaw, Poland;10. Institute for Cardiac Diagnostic and Therapy, Berlin, Germany;11. Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main, Germany |
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Abstract: | ObjectivesThe goal of this study was to examine prognostic relationships between cardiac imaging measures and cardiovascular outcome in people living with human immunodeficiency virus (HIV) (PLWH) on highly active antiretroviral therapy (HAART).BackgroundPLWH have a higher prevalence of cardiovascular disease and heart failure (HF) compared with the noninfected population. The pathophysiological drivers of myocardial dysfunction and worse cardiovascular outcome in HIV remain poorly understood.MethodsThis prospective observational longitudinal study included consecutive PLWH on long-term HAART undergoing cardiac magnetic resonance (CMR) examination for assessment of myocardial volumes and function, T1 and T2 mapping, perfusion, and scar. Time-to-event analysis was performed from the index CMR examination to the first single event per patient. The primary endpoint was an adjudicated adverse cardiovascular event (cardiovascular mortality, nonfatal acute coronary syndrome, an appropriate device discharge, or a documented HF hospitalization).ResultsA total of 156 participants (62% male; age median, interquartile range]: 50 years 42 to 57 years]) were included. During a median follow-up of 13 months (9 to 19 months), 24 events were observed (4 HF deaths, 1 sudden cardiac death, 2 nonfatal acute myocardial infarction, 1 appropriate device discharge, and 16 HF hospitalizations). Patients with events had higher native T1 (median interquartile range]: 1,149 ms 1,115 to 1,163 ms] vs. 1,110 ms 1,075 to 1,138 ms]); native T2 (40 ms 38 to 41 ms] vs. 37 ms 36 to 39 ms]); left ventricular (LV) mass index (65 g/m2 49 to 77 g/m2] vs. 57 g/m2 49 to 64 g/m2]), and N-terminal pro–B-type natriuretic peptide (109 pg/l 25 to 337 pg/l] vs. 48 pg/l 23 to 82 pg/l]) (all p < 0.05). In multivariable analyses, native T1 was independently predictive of adverse events (chi-square test, 15.9; p < 0.001; native T1 10 ms] hazard ratio 95% confidence interval]: 1.20 1.08 to 1.33]; p = 0.001), followed by a model that also included LV mass (chi-square test, 17.1; p < 0.001). Traditional cardiovascular risk scores were not predictive of the adverse events.ConclusionsOur findings reveal important prognostic associations of diffuse myocardial fibrosis and LV remodeling in PLWH. These results may support development of personalized approaches to screening and early intervention to reduce the burden of HF in PLWH (International T1 Multicenter Outcome Study; NCT03749343). |
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Keywords: | cardiac magnetic resonance myocardial fibrosis scar CI"} {"#name":"keyword" "$":{"id":"kwrd0030"} "$$":[{"#name":"text" "_":"confidence interval CMR"} {"#name":"keyword" "$":{"id":"kwrd0040"} "$$":[{"#name":"text" "_":"cardiac magnetic resonance D:A:D"} {"#name":"keyword" "$":{"id":"kwrd0050"} "$$":[{"#name":"text" "_":"Data Collection on Adverse Effects of Anti-HIV Drugs HAART"} {"#name":"keyword" "$":{"id":"kwrd0060"} "$$":[{"#name":"text" "_":"highly active antiretroviral therapy HF"} {"#name":"keyword" "$":{"id":"kwrd0070"} "$$":[{"#name":"text" "_":"heart failure HIV"} {"#name":"keyword" "$":{"id":"kwrd0080"} "$$":[{"#name":"text" "_":"human immunodeficiency virus HR"} {"#name":"keyword" "$":{"id":"kwrd0090"} "$$":[{"#name":"text" "_":"hazard ratio hs-TnT"} {"#name":"keyword" "$":{"id":"kwrd0100"} "$$":[{"#name":"text" "_":"high-sensitivity troponin T IQR"} {"#name":"keyword" "$":{"id":"kwrd0110"} "$$":[{"#name":"text" "_":"interquartile range LV"} {"#name":"keyword" "$":{"id":"kwrd0120"} "$$":[{"#name":"text" "_":"left ventricular LGE"} {"#name":"keyword" "$":{"id":"kwrd0130"} "$$":[{"#name":"text" "_":"late gadolinium enhancement MAGGIC"} {"#name":"keyword" "$":{"id":"kwrd0140"} "$$":[{"#name":"text" "_":"Meta-Analysis Global Group in Chronic Heart Failure Risk Score MOLLI"} {"#name":"keyword" "$":{"id":"kwrd0150"} "$$":[{"#name":"text" "_":"modified Look-Locker imaging NT-proBNP"} {"#name":"keyword" "$":{"id":"kwrd0160"} "$$":[{"#name":"text" "_":"N-terminal pro–B-type natriuretic peptide PLWH"} {"#name":"keyword" "$":{"id":"kwrd0170"} "$$":[{"#name":"text" "_":"people living with human immunodeficiency virus |
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