Increased arterial inflammation relates to high-risk coronary plaque morphology in HIV-infected patients.
Increased arterial inflammation relates to high-risk coronary plaque morphology in HIV-infected patients.
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DOI：
10.1097/qai.0000000000000138
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发表时间：
2014-06-01
期刊：
影响因子：
--
通讯作者：
Grinspoon S
中科院分区：
文献类型：
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作者：
Tawakol A;Lo J;Zanni MV;Marmarelis E;Ihenachor EJ;MacNabb M;Wai B;Hoffmann U;Abbara S;Grinspoon S
艾滋病毒感染患者易患心血管疾病风险增加的机制尚不清楚。目的：探讨HIV感染亚临床冠状动脉粥样硬化患者动脉炎症与高危斑块形态之间的相互关系。应用18F-FDG-PET对41例经冠状动脉CT血管造影术证实有动脉粥样硬化斑块但无明确心血管疾病的HIV感染患者进行了18F-FDG-PET检查。根据动脉炎症的相对程度(主动脉靶背景比，或TBR)，患者被分成两组。比较两组高危冠状动脉粥样硬化斑块的形态特征。对于传统的心血管危险参数，具有较高和较低TBR的HIV感染患者是相似的。在具有较高TBR的HIV感染患者中，至少有一个低密度冠状动脉斑块(40%比10%，p=0.02)和至少一个低密度和正重构的冠状动脉动脉粥样硬化斑块(35%比10%，p=0.04)的患者比例增加。此外，在高TBR组，每个患者的低密度斑块(LAP‘s)数量(p=0.02)和最脆弱斑块中的易损特征数量(p=0.02)都增加了。在控制了年龄、性别、低密度脂蛋白、艾滋病毒持续时间和CD4时，总胆红素分组仍然与LAP/受试者的数量显著相关(β=0.35，p=0.004)。这些数据表明，在HIV感染的亚临床冠状动脉粥样硬化患者中，18F-FDG-PET的动脉炎症与高危冠状动脉粥样硬化斑块特征之间存在关系。还需要进一步的研究来确定动脉炎症和相关的高危冠状动脉形态是否会增加HIV人群中临床心血管事件的风险。
Mechanisms predisposing HIV-infected patients to increased CVD risk remain unclear. To determine the interrelationship between arterial inflammation and high-risk coronary plaque morphology in HIV-infected patients with subclinical coronary atherosclerosis. 41 HIV-infected patients on stable ART without known CVD but with atherosclerotic plaque on coronary CT angiography were evaluated with 18F-FDG-PET. Patients were stratified into two groups based on relative degree of arterial inflammation (aortic target-to-background-ratio, or TBR). High-risk coronary atherosclerotic plaque morphology features were compared between groups. HIV-infected patients with higher and lower TBR’s were similar with respect to traditional CVD risk parameters. Among HIV-infected patients with higher TBR, an increased percentage of patients demonstrated at least one low attenuation coronary atherosclerotic plaque (40% vs. 10%, p = 0.02) and at least one coronary atherosclerotic plaque with both low attenuation and positive remodeling (35% vs. 10%, p = 0.04). Moreover, in the higher TBR group, both the number of low attenuation plaques (LAP’s) per patient (p = 0.02) and the number of vulnerability features in the most vulnerable plaque (p = 0.02) were increased. TBR grouping remained significantly related to the number of LAP’s/subject (β=0.35, p = 0.004), controlling for age, gender, LDL, duration HIV, and CD4. These data demonstrate a relationship between arterial inflammation on 18F-FDG-PET and high-risk coronary atherosclerotic plaque features among HIV-infected patients with sublclinical coronary atherosclerosis. Further studies are needed to determine whether arterial inflammation and related high-risk coronary morphology increase the risk of clinical CVD events in the HIV population.