Prevalence and prognostic significance of ECG abnormalities in HIV-infected patients: results from the Strategies for Management of Antiretroviral Therapy study |
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| Authors: | Soliman Elsayed Z Prineas Ronald J Roediger Mollie P Duprez Daniel A Boccara Franck Boesecke Christoph Stephan Christoph Hodder Sally Stein James H Lundgren Jens D Neaton James D |
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| Affiliation: | aEpidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC;bDepartment of Biostatistics, University of Minnesota, Minneapolis, MN;cDepartment of Medicine, University of Minnesota, Minneapolis, MN;dCardiology Department, Saint-Antoine University and Medical School, France;eNational Centre in HIV Epidemiology and Clinical Research, Sydney, Australia;fHIV Treatment and Clinical Research Unit, Medical Department, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany;gHIV/AIDS Program, Department of Medicine, University of Medicine and Dentistry of New Jersey, Newark, NJ;hSchool of Medicine and Public Health, University of Wisconsin School of Medicine and Public Health, Madison, WI;iCopenhagen HIV Programme (CHIP), State University Hospital and University of Copenhagen, Copenhagen, Denmark |
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| Abstract: | BackgroundIt remains debated whether to include resting electrocardiogram (ECG) in the routine care of human immunodeficiency virus (HIV)–infected patients.MethodsThis analysis included 4518 HIV-infected patients (28% women and 29% blacks) from the Strategies for Management of Antiretroviral Therapy study, a clinical trial aimed to compare 2 HIV treatment strategies. ECG abnormalities were classified using the Minnesota Code. Cox proportional hazards analysis was used to examine the association between baseline ECG abnormalities and incident cardiovascular disease (CVD).ResultsMore than half of the participants (n = 2325, or 51.5%) had either minor or major ECG abnormalities. Minor ECG abnormalities (48.6%) were more common than major ECG abnormalities (7.7%). During a median follow-up of 28.7 months, 155 participants (3.4%) developed incident CVD. After adjusting for the study-treatment arms, the presence of major, minor, and either minor or major ECG abnormalities was significantly predictive of incident CVD (hazard ratio [95% confidence interval]: 2.76 [1.74-4.39], P < .001; 1.58 [1.14-2.20], P = .006; 1.57 [1.14-2.18], P = .006, respectively). However, after adjusting for demographics, CVD risk factors, and HIV characteristics (full model), presence of major ECG abnormalities were still significantly predictive of CVD (1.83 [1.12-2.97], P = .015) but not minor or major abnormalities taken together (1.26 [0.89-1.79], P = .18; 1.25 [0.89-1.76], P = .20, respectively). Individual ECG abnormalities that significantly predicted CVD in the fully adjusted model included major isolated ST-T abnormalities, major prolongation of QT interval, minor isolated ST-T, and minor isolated Q-QS abnormalities.ConclusionNearly 1 in 2 of the HIV-infected patients in our study had ECG abnormalities; 1 in 13 had major ECG abnormalities. Presence of ECG abnormalities, especially major ECG abnormalities, was independently predictive of incident CVD. These results suggest that the ECG could provide a convenient risk-screening tool in HIV-infected patients. |
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| Keywords: | HIV/AIDS ECG Cardiovascular disease SMART study |
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