title: Should HIV-infected patients be screened for silent myocardial ischaemia using gated myocardial perfusion SPECT?
abstract: OBJECTIVE
  A higher prevalence of cardiovascular risk factors (CRFs) in HIV-infected patients, together with chronic infection and treatments, has resulted in an increased risk of silent myocardial ischaemia (SMI). The objective of this study was to evaluate whether myocardial SPECT should be used for screening HIV-infected patients with no clinical symptoms of coronary artery disease.
  
  
  METHODS
  The prevalence of SMI detected by myocardial SPECT was determined in 94 HIV-infected patients with a normal clinical cardiovascular examination in relation to anthropomorphic parameters, CRFs, inflammatory and HIV infection status, and treatment.
  
  
  RESULTS
  Coronary artery disease was detected in nine patients (eight with ischaemia, one with myocardial infarction), corresponding to 9.6 % positivity. All but two of the scintigraphic diagnoses of ischaemia were confirmed by coronarography. Univariate analysis revealed that the overall number of CRFs and the combination of gender and age were associated with a diagnosis of SMI (p < 0.05). According to multivariate analysis, the only independent parameter significantly associated with the scintigraphic diagnosis of SMI was the combination of gender and age (p = 0.01). All the positive myocardial SPECT scans were in men older than 52 years with at least two other CRFs. In this subpopulation of 47 patients, the prevalence of SMI detected by myocardial SPECT reached 19.2 %.
  
  
  CONCLUSIONS
  In male HIV-infected patients older than 52 years and with at least two other CRFs, screening for SMI using myocardial SPECT was about four times more likely to be positive than in the general population. This may motivate physicians to advise these patients to undergo more systematic screening for SMI using this technique.
authors.affiliation: Department of Nuclear Medicine, Montpellier University Hospital, Montpellier, France. d-mariano_goulart@chu-montpellier.fr
authors.forename: Denis
authors.initials: D
authors.lastname: Mariano-Goulart
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Jacquet
authors.forename: Nicolas
authors.initials: N
authors.lastname: Molinari
authors.forename: Aurélie
authors.initials: A
authors.lastname: Bourdon
authors.forename: Meriem
authors.initials: M
authors.lastname: Benkiran
authors.forename: Mélanie
authors.initials: M
authors.lastname: Sainmont
authors.forename: Luc
authors.initials: L
authors.lastname: Cornillet
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Macia
authors.forename: Jacques
authors.initials: J
authors.lastname: Reynes
authors.forename: Fayçal
authors.initials: F
authors.lastname: Ben Bouallègue
mesh_terms: D000368:Aged; D000465:Algorithms; D000886:Anthropometry / Q000379:methods; D044966:Anti-Retroviral Agents / Q000494:pharmacology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D016017:Odds Ratio; D010477:Perfusion; D015995:Prevalence; D011877:Radionuclide Imaging / Q000379:methods; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D044966:Anti-Retroviral Agents