Normal Myocardial Flow Reserve in HIV-Infected Patients on Stable Antiretroviral Therapy: A Cross-Sectional Study Using Rubidium-82 PET/CT

TY - JOUR

T1 - Normal Myocardial Flow Reserve in HIV-Infected Patients on Stable Antiretroviral Therapy

T2 - A Cross-Sectional Study Using Rubidium-82 PET/CT

AU - Knudsen, Andreas

AU - Christensen, Thomas E

AU - Ghotbi, Adam Ali

AU - Hasbak, Philip

AU - Lebech, Anne-Mette

AU - Kjær, Andreas

AU - Ripa, Rasmus Sejersten

PY - 2015/10

Y1 - 2015/10

N2 - Studies have found HIV-infected patients to be at increased risk of myocardial infarction, which may be caused by coronary microvascular dysfunction. For the first time among HIV-infected patients, we assessed the myocardial flow reserve (MFR) by Rubidium-82 (82Rb) positron emission tomography (PET), which can quantify the coronary microvascular function. MFR has proved highly predictive of future coronary artery disease and cardiovascular events in the general population.In a prospective cross-sectional study, HIV-infected patients all receiving antiretroviral therapy (ART) with full viral suppression and HIV-uninfected controls were scanned using 82Rb PET/computed tomography at rest and adenosine-induced stress, thereby obtaining the MFR (stress flow/rest flow), stratified into low ≤1.5, borderline >1.5 to 2.0, or normal >2.0.Fifty-six HIV-infected patients and 25 controls were included. The HIV-infected patients had a mean age of 53 years (range 37-68 years) with 23% active smokers. The controls had a mean age of 52 years (range 36-68 years) and 26% active smokers. In the HIV-infected group 73% had a normal MFR, 17% borderline, and 10% low values of MFR. Among controls these values were 71%, 19%, and 10%, respectively (P = 0.99). However, the HIV-infected group had lower values of stress myocardial blood flow (MBF) (2.63 ± 0.09 mL/g/min vs 2.99 ± 0.14 mL/g/min; P = 0.03). We found no evidence of decreased MFR as assessed by 82Rb PET among HIV-infected patients on stable ART with full viral suppression compared with HIV-uninfected controls. We did notice a decreased MBF during stress.

AB - Studies have found HIV-infected patients to be at increased risk of myocardial infarction, which may be caused by coronary microvascular dysfunction. For the first time among HIV-infected patients, we assessed the myocardial flow reserve (MFR) by Rubidium-82 (82Rb) positron emission tomography (PET), which can quantify the coronary microvascular function. MFR has proved highly predictive of future coronary artery disease and cardiovascular events in the general population.In a prospective cross-sectional study, HIV-infected patients all receiving antiretroviral therapy (ART) with full viral suppression and HIV-uninfected controls were scanned using 82Rb PET/computed tomography at rest and adenosine-induced stress, thereby obtaining the MFR (stress flow/rest flow), stratified into low ≤1.5, borderline >1.5 to 2.0, or normal >2.0.Fifty-six HIV-infected patients and 25 controls were included. The HIV-infected patients had a mean age of 53 years (range 37-68 years) with 23% active smokers. The controls had a mean age of 52 years (range 36-68 years) and 26% active smokers. In the HIV-infected group 73% had a normal MFR, 17% borderline, and 10% low values of MFR. Among controls these values were 71%, 19%, and 10%, respectively (P = 0.99). However, the HIV-infected group had lower values of stress myocardial blood flow (MBF) (2.63 ± 0.09 mL/g/min vs 2.99 ± 0.14 mL/g/min; P = 0.03). We found no evidence of decreased MFR as assessed by 82Rb PET among HIV-infected patients on stable ART with full viral suppression compared with HIV-uninfected controls. We did notice a decreased MBF during stress.

KW - Anti-Retroviral Agents

KW - Case-Control Studies

KW - Coronary Circulation

KW - Cross-Sectional Studies

KW - Female

KW - HIV Infections

KW - Heart

KW - Humans

KW - Male

KW - Middle Aged

KW - Positron-Emission Tomography

KW - Rubidium Radioisotopes

KW - Stroke Volume

U2 - 10.1097/MD.0000000000001886

DO - 10.1097/MD.0000000000001886

M3 - Journal article

C2 - 26512605

SN - 0025-7974

VL - 94

JO - Medicine (Baltimore)

JF - Medicine (Baltimore)

IS - 43

M1 - e1886

ER -