Myocardial Fibrosis and Inflammation by CMR Predict Cardiovascular Outcome in People Living With HIV
Myocardial Fibrosis and Inflammation by CMR Predict Cardiovascular Outcome in People Living With HIV
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DOI：
10.1016/j.jcmg.2021.01.042
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发表时间：
2021-08-02
影响因子：
14
通讯作者：
Puntmann, Valentina O.
中科院分区：
文献类型：
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作者：
de Leuw, Philipp;Arendt, Christophe T.;Puntmann, Valentina O.
本研究的目的是研究心脏成像措施和高活性抗逆转录病毒治疗（HAART）的人类免疫缺陷病毒（HIV）（PLWH）患者的心血管结局之间的预后关系。背景PLWH与非感染人群相比，心血管疾病和心力衰竭（HF）的患病率较高。HIV.METHODS这种前瞻性观察纵向研究包括连续PLWH长期HAART进行心脏磁共振（CMR）检查评估心肌体积和功能，T1和T2映射，灌注和疤痕的病理生理驱动程序的心肌功能障碍和更糟糕的心血管结局仍然知之甚少。从索引CMR检查到每例患者的首起单一事件，进行了至事件发生时间分析。主要终点是判定的不良心血管事件（心血管死亡率，非致命性急性冠脉综合征，适当的设备出院，或有记录的HF住院治疗）。结果共有156名参与者（62%男性;年龄[中位数，四分位数范围]：50岁[42至57岁]）。在中位随访13个月（9 - 19个月）期间，观察到24起事件（4例HF死亡，1例心源性猝死，2例非致死性急性心肌梗死，1例适当器械出院和16例HF住院）。发生事件的患者的天然T1较高（中位数[四分位距]：1，149 ms [1，115至1，163 ms] vs. 1，110 ms [1，075至1，138 ms]）;自体T2（40 ms [38至41 ms]对比37 ms [36至39 ms]）;左心室质量指数（65 g/m2 [49至77 g/m2]对比57 g/m2 [49至64 g/m2]），和N-末端B型利钠肽原（109 pg/l [25 - 337 pg/l] vs. 48 pg/l [23 - 82 pg/l]）（所有p < 0.05）。在多变量分析中，天然T1是不良事件的独立预测因素（卡方检验，15.9; p < 0.001;天然T1 [10 ms]风险比[95%置信区间]：1.20 [1.08 - 1.33]; p = 0.001），其次是包括LV质量的模型（卡方检验，17.1; p < 0.001）。传统的心血管风险评分不能预测不良事件。结论：我们的研究结果揭示了PLWH中弥漫性心肌纤维化和左室重构的重要预后相关性。这些结果可能支持开发个性化的筛查和早期干预方法，以减少PLWH（C）2021中HF的负担。由Elsevier代表美国心脏病学会基金会发布。
OBJECTIVES The 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).BACKGROUND PLWH 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.METHODS This 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).RESULTS A 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/m(2) [49 to 77 g/m(2)] vs. 57 g/m(2) [49 to 64 g/m(2)]), 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.CONCLUSIONS Our 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 (C) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.