Display options
Cite
Muccini C, Galli L, Poli A, et al. Exercise ECG for coronary artery disease screening in people living with HIV. AIDS. 2021;35(6):933-938doi: 10.1097/QAD.0000000000002828.
Muccini, C., Galli, L., Poli, A., Godino, C., Gianotti, N., Nozza, S., Giusti, M. C., Lazzarin, A., Margonato, A., Castagna, A., & Spagnuolo, V. (2021). Exercise ECG for coronary artery disease screening in people living with HIV. AIDS (London, England), 35(6), 933-938. https://doi.org/10.1097/QAD.0000000000002828
Muccini, Camilla, et al. "Exercise ECG for coronary artery disease screening in people living with HIV." AIDS (London, England) vol. 35,6 (2021): 933-938. doi: https://doi.org/10.1097/QAD.0000000000002828
Muccini C, Galli L, Poli A, Godino C, Gianotti N, Nozza S, Giusti MC, Lazzarin A, Margonato A, Castagna A, Spagnuolo V. Exercise ECG for coronary artery disease screening in people living with HIV. AIDS. 2021 May 01;35(6):933-938. doi: 10.1097/QAD.0000000000002828. PMID: 33534202.
Copy Download .nbib Format: NLM
Share it on

AIDS. 2021 May 01;35(6):933-938. doi: 10.1097/QAD.0000000000002828.

Exercise ECG for coronary artery disease screening in people living with HIV.

AIDS (London, England)

Camilla Muccini, Laura Galli, Andrea Poli, Cosmo Godino, Nicola Gianotti, Silvia Nozza, Maria C Giusti, Adriano Lazzarin, Alberto Margonato, Antonella Castagna, Vincenzo Spagnuolo

Affiliations

  1. Faculty of Medicine and Surgery, Vita-Salute San Raffaele University.
  2. Infectious Diseases Department.
  3. Division of Clinical Cardiology, Cardiothoracovascular Department.
  4. Department of Clinical Neuroscience, San Raffaele Scientific Institute, Milan, Italy.

PMID: 33534202 DOI: 10.1097/QAD.0000000000002828

Abstract

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.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

References

  1. Sabin CA, Reiss P. Epidemiology of ageing with HIV: what can we learn from cohorts?. AIDS 2017; 31: (Suppl 2): S121–S128. - PubMed
  2. Palella FJ Jr, Hart R, Armon C, Tedaldi E, Yangco B, Novak R, et al. Non-AIDS comorbidity burden differs by sex, race, and insurance type in aging adults in HIV care. AIDS 2019; 33:2327–2335. - PubMed
  3. Shah ASV, Stelzle D, Lee KK, Beck EJ, Alam S, Clifford S, et al. Global burden of atherosclerotic cardiovascular disease in people living with HIV: systematic review and meta-analysis. Circulation 2018; 138:1100–1112. - PubMed
  4. Longenecker CT, Funderburg NT, Jiang Y, Debanne S, Storer N, Labbato DE, et al. Markers of inflammation and CD8 T-cell activation, but not monocyte activation, are associated with subclinical carotid artery disease in HIV-infected individuals. HIV Med 2013; 14:385–390. - PubMed
  5. Mujawar Z, Rose H, Morrow MP, Pushkarsky T, Dubrovsky L, Mukhamedova N, et al. Human immunodeficiency virus impairs reverse cholesterol transport from macrophages. PLoS Biol 2006; 4:e365. - PubMed
  6. Grunfeld C, Delaney JAC, Wanke C, Currier JS, Scherzer R, Biggs ML, et al. Preclinical atherosclerosis due to hiv infection: carotid intima-medial thickness measurements from the FRAM study. AIDS 2009; 23:1841–1849. - PubMed
  7. Hsue PY, Waters DD. HIV infection and coronary heart disease: mechanisms and management. Nat Rev Cardiol 2019; 16:745–759. - PubMed
  8. Moran CA, Southmayd G, Devireddy CM, Quyyumi AA, Ofotokun I, Liberman HA, et al. Clinical and procedural characteristics of persons living with HIV presenting with acute coronary syndrome. AIDS 2020; 34:81–90. - PubMed
  9. Postigo A, Díez-Delhoyo F, Devesa C, Bruña V, Clavero-Olmos M, Vicent L, et al. Clinical profile, anatomical features, and long-term outcome of acute coronary syndromes in HIV-infected patients. Intern Med J 2020; 50:1518–1523. - PubMed
  10. Anand S, Bradshaw C, Prabhakaran D. Prevention and management of CVD in LMICs: why do ethnicity, culture, and context matter?. BMC Med 2020; 18:7. - PubMed
  11. Yusuf S, Rangarajan S, Teo K, Islam S, Li W, Liu L, et al. Cardiovascular risk and events in 17 low-, middle, and high-income countries. N Engl J Med 2014; 371:818–827. - PubMed
  12. Feinstein MJ, Bahiru E, Achenbachet C, Longenecker CT, Hsue P, So-Armah K, et al. Patterns of cardiovascular mortality for HIV-infected adults in the United States: 1999 to 2013. Am J Cardiol 2016; 117:214–220. - PubMed
  13. Hentzien M, Dramé M, Delpierre C, Allavena C, Cabié A, Cuzin L, et al. HIV-related excess mortality and age-related comorbidities in patients with HIV aged ≥60: a relative survival analysis in the French Dat’AIDS Cohort. BMJ Open 2019; 9:e024841. - PubMed
  14. European AIDS Clinical Society Guidelines for treatment of people living with HIV version 10.0, November 2019. Available at: https://www.eacsociety.org/files/2019_guidelines-10.0_final.pdf. [Accessed 5 August 2020] - PubMed
  15. Feinstein MJ, Hsue PY, Benjamin LA, Bloomfield GS, Currier JS, Freiberg MS, et al. Characteristics, prevention, and management of cardiovascular disease in people living with HIV: a scientific statement from the American Heart Association. Circulation 2019; 140:e98–e124. - PubMed
  16. Triant VA, Perez J, Regan S, Massaro JM, Meigs JB, Grinspoon SK, et al. Cardiovascular risk prediction functions underestimate risk in HIV infection. Circulation 2018; 137:2203–2214. - PubMed
  17. de Groot E, Hovingh GK, Wiegman A, Duriez P, Smit AJ, Fruchart JC, et al. Measurement of arterial wall thickness as a surrogate marker for atherosclerosis. Circulation 2004; 109: (23 Suppl): I33–I38. - PubMed
  18. Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, et al. Exercise standards for testing and training. A statement for healthcare professionals from the American Heart Association. Circulation 2001; 104:1694–1740. - PubMed
  19. Garner KK, Pomeroy W, Arnold JJ. Exercise stress testing: indications and common questions. Am Fam Physician 2017; 1:293–299. - PubMed
  20. Bourque JM, Beller GA. Value of exercise ECG for risk stratification in suspected or known CAD in the era of advanced imaging technologies. JACC Cardiovasc Imaging 2015; 8:1309–1321. - PubMed
  21. Duong M, Cottin Y, Piroth L, Fargeot A, Lhuiller I, Bobillier ML, et al. Exercise stress testing for detection of silent myocardial ischemia in human immunodeficiency virus-infected patients receiving antiretroviral therapy. Clin Infect Dis 2002; 15:523–528. - PubMed
  22. De Lorenzo A, Meirelles V, Vilela F, Souza FC. Use of the exercise treadmill test for the assessment of cardiac risk markers in adults infected with HIV. J Int Assoc Provid AIDS Care 2013; 12:110–116. - PubMed
  23. Touboul PJ, Hennerici MG. Mannheim carotid intima–media thickness and plaque consensus (2004–2006–2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis 2012; 34:290–296. - PubMed
  24. Kaminsky LA, Whaley MH. Evaluation of a new standardized ramp protocol: the BSU/Bruce Ramp Protocol. J Cardiopulm Rehabil 1998; 18:438–444. - PubMed
  25. Fleg JL, Gerstenblith G, Zonderman AB, Becker LC, Weisfeldt ML, Costa PT Jr, et al. Prevalence and prognostic significance of exercise-induced silent myocardial ischemia detected by thallium scintigraphy and electrocardiography in asymptomatic volunteers. Circulation 1990; 81:428–436. - PubMed
  26. Zellweger MJ, Hachamovitch R, Kang X, Hayes SW, Friedman JD, Germano G, et al. Threshold, incidence, and predictors of prognostically high-risk silent ischemia in asymptomatic patients without prior diagnosis of coronary artery disease. J Nucl Cardiol 2009; 16:193–200. - PubMed
  27. Rosenson RS, Hubbard D, Monda KL, Reading SR, Chen L, Dluzniewski PJ, et al. Excess risk for atherosclerotic cardiovascular outcomes among US adults with HIV in the current era. J Am Heart Assoc 2020; 9:e013744. - PubMed
  28. Kral BG, Becker DM, Vaidya D, Yanek LR, Becker LC. Severity of inducible myocardial ischemia predicts incident acute coronary syndromes in asymptomatic individuals with a family history of premature coronary artery disease. J Nucl Cardiol 2012; 19:28–36. - PubMed
  29. DeLuca AJ, Kaplan S, Aronow WS, Sandhu R, Butt A, Akoybyan A, et al. Comparison of prevalence of unrecognized myocardial infarction and of silent myocardial ischemia detected by a treadmill exercise sestamibi stress test in patients with versus without diabetes mellitus. Am J Cardiol 2006; 98:1045–1046. - PubMed
  30. Rao SG, Galaviz KI, Gay HC, Wei J, Armstrong WS, Del Rio C, et al. Factors associated with excess myocardial infarction risk in HIV-infected adults: a systematic review and meta-analysis. J Acquir Immune Defic Syndr 2019; 81:224–230. - PubMed
  31. Masiá M, Padilla S, García JA, Bernardino JI, Campins AA, Asensi V, et al. for the Cohort of HIV Adults of the AIDS Research Network (CoRIS) study. Decreasing rates of acute myocardial infarction in people living with HIV: a nationwide cohort study in Spain, 2004–2015. HIV Med 2018; doi: 10.1111/hiv.12616. - PubMed
  32. Nadel J, Holloway CJ. Screening and risk assessment for coronary artery disease in HIV infection: an unmet need. HIV Med 2017; 18:292–299. - PubMed
  33. Stein JH, Currier JS, Hsue PY. Arterial disease in patients with human immunodeficiency virus infection: what has imaging taught us?. JACC Cardiovasc Imaging 2014; 7:515–525. - PubMed
  34. Senoner T, Barbieri F, Adukauskaite A, Sarcletti M, Plank F, Beyer C, et al. Coronary atherosclerosis characteristics in HIV-infected patients on long-term antiretroviral therapy: insights from coronary computed tomography-angiography. AIDS 2019; 33:1853–1862. - PubMed

MeSH terms

Publication Types