title: A clinical approach for cardiovascular monitoring of HIV-infected patients. Results from an observational cohort study.
abstract: BACKGROUND
  HIV infection is one of the leading causes of acquired heart disease. Because of its high diffusion, systematic echocardiographic monitoring has been proposed to exclude cardiovascular involvement in these patients. The aim of this study was to evaluate an alternative clinical approach by which echocardiographic screening is limited to patients with a clinical suspicion of heart disease.
  
  
  METHODS
  We studied 2030 consecutive HIV-infected patients admitted to a tertiary referral hospital (group A). History, physical examination, ECG, and chest X-ray were used to screen HIV-infected patients for cardiovascular involvement. Selected patients were extensively studied, first of all by echocardiography. Cardiovascular and non-cardiovascular deaths were recorded:
  
  
  RESULTS
  Cardiovascular involvement was clinically suspected in 201 patients (9.9%; group B). Among them a higher extracardiac mortality was found in presence of pericardial disease (odds ratio [OR] 4.27, 95% confidence interval [CI] 2.01-9.09), while a higher cardiovascular mortality was recorded for patients with cardiomyopathy or myocarditis (OR 2.72, 95% CI 1.09-6.81), and right ventricular dysfunction and/or pulmonary hypertension (OR 4.67, 95% CI 1.44-15.2). Compared with group A, patients in group B had a significantly increased cardiac death rate (0.114 vs 0.018, p < 0.001). A positive echocardiogram slightly increased this rate (from 0.114 to 0.164, p = NS), whereas a negative echocardiogram significantly decreased the cardiac death rate (0.015 vs 0.164, p = 0.004).
  
  
  CONCLUSIONS
  Clinical selection of HIV-infected patients with suspected cardiovascular involvement may help identify patients with higher frequency of cardiovascular involvement. Among these patients, echocardiography may be a useful screening tool in those at high risk for cardiovascular death.
authors.affiliation: Cardiology Department, Maria Vittoria Hospital, ASL 3, Turin, Italy. cecchi.enrico@tin.it
authors.forename: Enrico
authors.initials: E
authors.lastname: Cecchi
authors.forename: Massimo
authors.initials: M
authors.lastname: Imazio
authors.forename: Franco
authors.initials: F
authors.lastname: Pomari
authors.forename: Ivano
authors.initials: I
authors.lastname: Dal Conte
authors.forename: Costantina
authors.initials: C
authors.lastname: Preziosi
authors.forename: Filippo
authors.initials: F
authors.lastname: Lipani
authors.forename: Rita
authors.initials: R
authors.lastname: Trinchero
mesh_terms: D015331:Cohort Studies; D004452:Echocardiography; D015658:HIV Infections / Q000150:complications*; D006331:Heart Diseases / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods*