The Risk for Sudden Cardiac Death Among Patients Living With Heart Failure and Human Immunodeficiency Virus
The Risk for Sudden Cardiac Death Among Patients Living With Heart Failure and Human Immunodeficiency Virus
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DOI：
10.1016/j.jchf.2019.04.025
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发表时间：
2019-09-01
影响因子：
13
通讯作者：
Neilan, Tomas G.
中科院分区：
文献类型：
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作者：
Alvi, Raza M.;Neilan, Anne M.;Neilan, Tomas G.
本研究的目的是确定患有人类免疫缺陷病毒感染（PHIV）并伴有心力衰竭（HF）的患者中心脏性猝死（SCD）的发生率，以及与之相关的危险因素。PHIV导致心力衰竭的风险更高。方法这是一项回顾性研究，纳入了来自单一学术中心的2，578名心力衰竭住院患者，其中344名为PHIV。关注的结局为SCD。根据病毒载量（VL）和左心室射血分数（LVEF）<35%、35%~ 49%和>= 50%进行亚组分析。结果在2,578例HF患者中，2,149例（86%）未植入心律转复器;其中344例为PHIV，1,805例为未感染的对照组。在合并HF的PHIV患者中，313例（91%）接受了抗逆转录病毒治疗，64%的患者得到了病毒抑制。在19个月的中位随访期内，有191例SCD。与对照组相比，PHIV患者的SCD增加了3倍（21.0% vs. 6.4%;校正比值比：3.0; 95%置信区间：1.78 - 4.24）。在PHIV中，可卡因使用、较低的LVEF、无β受体阻滞剂处方和VL是SCD的预测因素。未检测到VL的PHIV患者的SCD率与未感染受试者的SCD率相似。按LVEF分层观察到相似结果。在PHIV与HF没有传统的适应症植入式心律转复除颤器，SCD的速度为10%，每年。结论PHIV住院HF是在显着增加SCD的风险。在LVEFs较低、CD 4计数较低和VL较高的患者中，SCD风险增加。(C)2019年由美国心脏病学会基金会。
OBJECTIVES The aim of this study was to determine the incidence of sudden cardiac death (SCD) among persons living with human immunodeficiency virus infection (PHIV) with heart failure (HF), who were hospitalized for HF, and the risk factors associated with it.BACKGROUND HF is associated with an increased risk for SCD. PHIV are at heightened risk for HF.METHODS This was a retrospective study of 2,578 patients hospitalized with HF from a single academic center, of whom 344 were PHIV. The outcome of interest was SCD. Subgroup analyses were performed by strata of viral load (VL) and left ventricular ejection fraction (LVEF) < 35%, 35% to 49%, and >= 50%.RESULTS Of 2,578 patients with HF, 2,149 (86%) did not have implantable cardioverter-defibrillators; of these, there were 344 PHIV and 1,805 uninfected control subjects. Among PHIV with HF, 313 (91%) were prescribed antiretroviral therapy and 64% were virally suppressed. There were 191 SCDs over a median follow-up period of 19 months. Compared with control subjects, PHIV had a 3-fold increase in SCD (21.0% vs. 6.4%; adjusted odds ratio: 3.0; 95% confidence interval: 1.78 to 4.24). Among PHIV, cocaine use, lower LVEF, absence of beta-blocker prescription, and VL were predictors of SCD. The SCD rate among PHIV with undetectable VL was similar to the rate among uninfected subjects. Similar findings were observed by LVEF strata. Among PHIV with HF without conventional indications for an implantable cardioverter-defibrillator, the rate of SCD was 10% per year.CONCLUSIONS PHIV hospitalized with HF are at a markedly increased risk for SCD. SCD risk was increased in patients with lower LVEFs, lower CD4 counts, and higher VL. (C) 2019 by the American College of Cardiology Foundation.