Incidence, Predictors, and Outcomes of Implantable Cardioverter-Defibrillator Discharge Among People Living With HIV.
Incidence, Predictors, and Outcomes of Implantable Cardioverter-Defibrillator Discharge Among People Living With HIV.
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DOI：
10.1161/jaha.118.009857
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发表时间：
2018-09-18
影响因子：
5.4
通讯作者：
Neilan TG
中科院分区：
文献类型：
--
作者：
Alvi RM;Neilan AM;Tariq N;Awadalla M;Rokicki A;Hassan M;Afshar M;Mulligan CP;Triant VA;Zanni MV;Neilan TG
HIV感染者（PHIV）的心脏性猝死风险增加，植入式心脏复律器（ICD）可预防SCD。目前还没有关于PHIV的发病率、预测因素和ICD治疗效果的数据。我们比较了59例PHIV和267例未感染对照组的ICD放电率。对于PHIV，我们测试了传统心血管风险因素和HIV特异性参数与ICD出院的相关性，然后测试了PHIV中ICD出院是否与心血管死亡率或心力衰竭入院相关。ICD插入的适应症在组间相似。与对照组相比，植入ICD的HIV感染者更容易患冠状动脉疾病和使用可卡因。在随访中，PHIV的ICD出院率更高（39% vs 20%; P = 0.001;中位随访期为19个月）。在PHIV中，可卡因使用、冠状动脉疾病、QRS时限和较高的纽约心脏协会分级与ICD放电相关。ICD出院具有预后影响，随后心力衰竭入院率增加1.7倍，心血管死亡率增加2倍，这种影响在种族/民族和性别类别中一致。 与未感染的对照组相比，PHIV患者的ICD出院率较高。在PHIV中，可卡因使用和纽约心脏协会分级与ICD放电增加相关，ICD放电与随后因心力衰竭和心血管死亡率入院的增加相关。
People living with HIV (PHIV) are at an increased risk for sudden cardiac death, and implantable cardioverter‐defibrillators (ICDs) prevent SCD. There are no data on the incidence, predictors, and effects of ICD therapies among PHIV. We compared ICD discharge rates between 59 PHIV and 267 uninfected controls. For PHIV, we tested the association of traditional cardiovascular risk factors and HIV‐specific parameters with an ICD discharge and then tested whether an ICD discharge among PHIV was associated with cardiovascular mortality or an admission for heart failure. The indication for ICD insertion was similar among groups. Compared with controls, PHIV with an ICD were more likely to have coronary artery disease and to use cocaine. In follow‐up, PHIV had a higher ICD discharge rate (39% versus 20%; P=0.001; median follow‐up period, 19 months). Among PHIV, cocaine use, coronary artery disease, QRS duration, and higher New York Heart Association class were associated with an ICD discharge. An ICD discharge had a prognostic effect, with a subsequent 1.7‐fold increase in heart failure admission and a 2‐fold increase in cardiovascular mortality, an effect consistent across racial/ethnic and sex categories. ICD discharge rates are higher among PHIV compared with uninfected controls. Among PHIV, cocaine use and New York Heart Association class are associated with increased ICD discharge, and an ICD discharge is associated with a subsequent increase in admission for heart failure and cardiovascular mortality.