Original Research
Myocardial Fibrosis and Inflammation by CMR Predict Cardiovascular Outcome in People Living With HIV

https://doi.org/10.1016/j.jcmg.2021.01.042Get rights and content
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Abstract

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).

Key Words

cardiac magnetic resonance
myocardial fibrosis
scar

Abbreviations and Acronyms

CI
confidence interval
CMR
cardiac magnetic resonance
D:A:D
Data Collection on Adverse Effects of Anti-HIV Drugs
HAART
highly active antiretroviral therapy
HF
heart failure
HIV
human immunodeficiency virus
HR
hazard ratio
hs-TnT
high-sensitivity troponin T
IQR
interquartile range
LV
left ventricular
LGE
late gadolinium enhancement
MAGGIC
Meta-Analysis Global Group in Chronic Heart Failure Risk Score
MOLLI
modified Look-Locker imaging
NT-proBNP
N-terminal pro–B-type natriuretic peptide
PLWH
people living with human immunodeficiency virus

Cited by (0)

Tim Leiner, MD, served as Guest Editor.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.

Drs. de Leuw and Arendt contributed equally to this work and are joint first authors.