Increased coronary atherosclerotic plaque vulnerability by coronary computed tomography angiography in HIV-infected men

作者：Markella V. Zanni, Suhny Abbara, Janet Lo, Bryan Wai, David Hark, Eleni Marmarelis, Steven Grinspoon · 发表于：AIDS · 年份：2013 · DOI：10.1097/qad.0b013e32835eca9b · 被引用次数：142 · 研究领域：HIV-related health complications and treatments、Cardiac Imaging and Diagnostics、Cardiovascular Health and Disease Prevention

OBJECTIVE: Among HIV-infected patients, high rates of myocardial infarction (MI) and sudden cardiac death have been observed. Exploring potential underlying mechanisms, we used multidetector spiral coronary computed tomography angiography (coronary CTA) to compare atherosclerotic plaque morphology in HIV-infected patients and non-HIV-infected controls. METHODS: Coronary atherosclerotic plaques visualized by CTA in HIV-infected (101) and non-HIV-infected (41) men without clinically apparent heart disease matched on cardiovascular risk factors were analyzed for three vulnerability features: low attenuation, positive remodeling, and spotty calcification. RESULTS: Ninety-five percent of HIV-infected patients were receiving ART (median duration 7.9 years) and had well controlled disease (median CD4 cell count, 473 cells/μl; median HIV RNA <50 copies/ml). Age and traditional cardiovascular risk factors were similar in HIV-infected patients and controls. Among the HIV-infected (versus control) group, there was a higher prevalence of patients with at least one: low attenuation plaque (22.8 versus 7.3%, P = 0.02), positively remodeled plaque (49.5 versus 31.7%, P = 0.05) and high-risk 3-feature plaque (7.9 versus 0%, P = 0.02). Moreover, patients in the HIV-infected (versus control) group demonstrated a higher number of low attenuation plaques (P = 0.01) and positively remodeled plaques (P = 0.03) per patient. CONCLUSION: Our data demonstrate an increased prevalence of vulnerable plaq...