Myocardial fibrosis and inflammation by CMR predict cardiovascular outcome in people living with HIV

  • 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/m2 [49 to 77 g/m2] vs. 57 g/m2 [49 to 64 g/m2]), 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 (International T1 Multicenter Outcome Study; NCT03749343).
Author:Philipp de LeuwGND, Christophe ArendtGND, Annette E. Haberl, Daniel Froadinadl, Gerrit KannGND, Timo WolfORCiDGND, Christoph StephanORCiDGND, Gundolf SchüttfortORCiDGND, Moises Vasquez, Luca ArcariORCiD, Hui Zhou, Hafisyatul ZainalORCiD, Monika GaworORCiD, Eleftherios Vidalakis, Michael Kolentinis, Moritz Hans Ernst AlbrechtORCiDGND, Felicitas EscherORCiDGND, Thomas J. VoglORCiDGND, Andreas M. ZeiherORCiDGND, Eike NagelORCiDGND, Valentina O. PuntmannORCiD
Parent Title (English):JACC Cardiovascular Imaging
Place of publication:Amsterdam
Document Type:Article
Date of Publication (online):2021/04/14
Date of first Publication:2021/04/14
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2023/02/09
Tag:cardiac magnetic resonance; myocardial fibrosis; scar
Page Number:10
First Page:1548
Last Page:1557
This study was supported by the German Ministry of Education and Research via the German Centre for Cardiovascular Research (DZHK) to Drs. Puntmann, Zeiher, and Nagel.
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - CC BY - Namensnennung 4.0 International