Infectious Disease

Myocardial fibrosis and LV remodeling can predict CV events in people with HIV

April 14, 2021

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In patients living with HIV on long-term, highly active antiretroviral therapy, diffuse myocardial fibrosis and left ventricular remodeling may predict adverse CV events, as published in JACC: Cardiovascular Imaging.

“These results together suggest a complex underlying pathophysiology in the development of heart disease in people with HIV, with diffuse interstitial myocardial fibrosis playing a prominent role in driving clinical outcome.” Philipp de Leuw, MD, Specialist in internal medicine and infectious diseases at the Infectiology Center Frankfurt in Germany, and colleagues wrote.

Diffuse myocardial fibrosis and left ventricular remodeling may predict adverse CV events in patients living with HIV on long-term, highly active antiretroviral therapy. The data were provided by de Leuw P et al. JACC Cardiovasc Imaging. 2021; doi: 10.1016 / j.jcmg.2021.01.042.

For the prospective study, the researchers included 156 consecutive participants who were living with HIV on highly active long-term antiretroviral therapy (mean age 50 years; 62% men) and who had undergone cardiac MRI. Measurements included myocardial volume and function, T1 and T2 mapping, perfusion, and scar. The primary endpoint was the first single CV event per patient that included CV mortality, non-fatal ACS, appropriate device discharge, or documented RF hospitalization. The median follow-up was 13 months.

The researchers reported that patients with HIV who had a first event had a higher native T1 (median 1,149 ms versus 1,110 ms) and a higher native T2 (40 ms versus 37 ms). LV mass (65 g / m2 vs. 57 g / m2) and N-terminal natriuretic peptide level of the pro-B type (109 pg / l vs. 48 pg / l; P for all <0.05) compared to those who did experience no CV event during follow-up.

Additionally, participants who experienced a first CV event had a lower LV ejection fraction than those who did not (median LVEF, 55% versus 58%; P = 0.052).

According to the study, native T1 was independently predictive of adverse CV events (chi-square test, 15.9; P <0.001; HR = 1.2; 95% CI, 1.08-1.33; P 0.001), followed by a model that also included LV mass (chi-square test, 17.1; P <0.001).

The researchers reported that traditional CV risk assessments do not predict the onset of adverse CV events in patients with HIV receiving highly active long-term antiretroviral therapy.

“Our results could help develop novel personalized approaches to cardioprotection, including screening and anti-remodeling treatment for pre-HF, to reduce HF exposure in people with HIV who are receiving highly active long-term antiretroviral therapy,” the researchers wrote .

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