Coronary atherosclerosis characteristics in HIV-infected patients on long-term antiretroviral therapy: insights from coronary computed tomography-angiography
Coronary atherosclerosis characteristics in HIV-infected patients on long-term antiretroviral therapy: insights from coronary computed tomography-angiography
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DOI：
10.1097/qad.0000000000002297
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发表时间：
2019-10-01
期刊：
影响因子：
3.8
通讯作者：
Feuchtner, Gudrun M.
中科院分区：
文献类型：
--
作者：
Senoner, Thomas;Barbieri, Fabian;Feuchtner, Gudrun M.
目的：本研究的目的是通过冠状动脉计算机断层扫描-血管造影（CCTA）评估接受长期抗逆转录病毒治疗（ART）的HIV感染者的冠状动脉疾病（CAD）特征。设计：回顾性病例对照配对队列研究。69例接受128层双源CCTA的HIV阳性患者（平均年龄54.9岁，26.1%为女性），平均17.8 +/- 9.4年的HIV感染和平均13 +/- 7.3年的ART持续时间与倾向评分匹配（1：1）年龄、性别、BMI和5个心血管危险因素与69名对照。评价CCTA的狭窄严重程度[根据冠状动脉疾病报告和数据系统（CAD-RADS）]、总斑块负荷[节段受累评分（SIS）和混合非钙化斑块负荷（G评分）]。作为炎症生物标志物，高危斑块（HRP）的功能（纳普金环征，低衰减斑块，斑点状钙化，正重塑），血管周围脂肪衰减指数（FAI），扩张冠状动脉进行了assessed.Results：CAD-RADS是艾滋病毒阳性参与者与对照组相比更高（2.21 +/- 1.4与1.69 +/- 1.5，P = 0.031）。HIV阳性者的CAD患病率和G评分（P = 0.043和P = 0.003）、HRP患病率[23例（34.3%）vs.8例（12.1%）; P = 0.002]和HRP数量[36例vs.10例，P < 0.001]均较高。27.8%的HRP血管周围FAI大于-70 Hounsfield单位。10例（14.5%）HIV阳性者冠状动脉扩张，对照组冠状动脉扩张率为0%（P = 0.003）。结论：长期ART治疗的HIV感染者冠状动脉非钙化和HRP负荷较高，与心血管疾病的危险性相关。此外，与对照组相比，HIV阳性个体显示出更高的狭窄严重程度（CAD-RADS）和更多的扩张冠状动脉。版权所有（C）2019威科医疗集团All rights reserved.
Objective: The aim of the study was to assess coronary artery disease (CAD) characteristics by coronary computed tomography-angiography (CCTA) in individuals with HIV infection on long-term antiretroviral therapy (ART)Design: Retrospective case-controlled matched cohort study.Methods: Sixty-nine HIV-positive patients who underwent 128-slice dual source CCTA (mean age 54.9 years, 26.1% women) with mean 17.8 +/- 9.4 years of HIV infection and a mean duration on ART of 13 +/- 7.3 years were propensity score-matched (1 : 1) for age, sex, BMI, and five cardiovascular risk factors with 69 controls. CCTA was evaluated for stenosis severity [according to Coronary Artery Disease - Reporting and Data System (CAD-RADS)], total plaque burden [segment involvement score (SIS) and mixed-noncalcified plaque burden (G-score)]. As inflammatory biomarkers, high-risk plaque (HRP) features (napkin-ring sign, low-attenuation plaque, spotty calcification, positive remodeling), perivascular fat attenuation index (FAI), and ectatic coronary arteries were assessed.Results: CAD-RADS was higher in HIV-positive participants as compared with controls (2.21 +/- 1.4 vs. 1.69 +/- 1.5, P = 0.031). A higher prevalence of CAD and G-score (P = 0.043 and P = 0.003) was found. HRP prevalence [23 (34.3%) vs. 8 (12.1%); P = 0.002] and the number of HRP (36 vs. 10, P < 0.001) were higher in HIV-positive individuals. A perivascular FAI greater than -70 Hounsfield units was present in 27.8% of HRP. Ectatic coronary arteries were found in 10 (14.5%) HIV-positive persons vs. 0% in controls (P = 0.003).Conclusion: Noncalcified and HRP burden in HIV-infected individuals on long-term ART is higher and associated with higher cardiovascular risk. Moreover, HIV-positive individuals displayed a higher stenosis severity (CAD-RADS) and more ectatic coronary arteries compared with the control group. Copyright (C) 2019 Wolters Kluwer Health, Inc. All rights reserved.