title: Silent ischemic heart disease and pericardial fat volume in HIV-infected patients: a case-control myocardial perfusion scintigraphy study.
abstract: OBJECTIVE
  to determine the prevalence of asymptomatic ischemic heart disease (IHD) in HIV patients by myocardial perfusion scintigraphy (MPS) and to determine the value of coronary artery calcium score (CACS), carotid intima-media thickness (cIMT) and pericardial fat volume as screening tools for detection of IHD in subjects with HIV.
  
  
  BACKGROUND
  Patients with HIV seem prone to early development of IHD.
  
  
  METHODS
  105 consecutive HIV patients (mean age 47.4 years; mean duration of HIV 12.3 years; mean CD4+ cell count 636×10⁶/L; all receiving antiretroviral therapy) and 105 controls matched for age, gender and smoking status, without history of IHD were recruited. MPS, CACS, cIMT, pericardial fat volume, and cardiovascular risk scores were measured.
  
  
  RESULTS
  HIV patients demonstrated higher prevalence of perfusion defects than controls (18% vs. 0%; p<0.001) despite similar risk scores. Of HIV patients with perfusion defects, 42% had a CACS = 0. CACS and cIMT were similar in HIV patients and controls. HIV patients on average had 35% increased pericardial fat volume and increased concentration of biomarkers of atherosclerosis in the blood. HIV patients with myocardial perfusion defects had increased pericardial fat volume compared with HIV patients without perfusion defects (314±43 vs. 189±12 mL; p<0.001).
  
  
  CONCLUSIONS
  HIV patients had an increased prevalence of silent IHD compared to controls as demonstrated by MPS. The finding was strongly associated with pericardial fat volume, whereas cardiovascular risk scores, cIMT and CACS seem less useful as screening tools for detection of myocardial perfusion defects in HIV patients.
authors: Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen, Denmark.
authors: Ulrik S
authors: US
authors: Kristoffersen
authors: Anne-Mette
authors: AM
authors: Lebech
authors: Niels
authors: N
authors: Wiinberg
authors: Claus L
authors: CL
authors: Petersen
authors: Philip
authors: P
authors: Hasbak
authors: Henrik
authors: H
authors: Gutte
authors: Gorm B
authors: GB
authors: Jensen
authors: Anne Mette F
authors: AM
authors: Hag
authors: Rasmus S
authors: RS
authors: Ripa
authors: Andreas
authors: A
authors: Kjaer
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D019380:Anti-HIV Agents / Q000627:therapeutic use; D058070:Asymptomatic Diseases; D015415:Biomarkers / Q000378:metabolism; D002118:Calcium / Q000378:metabolism; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D048429:Cell Size; D003331:Coronary Vessels / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000000981:diagnostic imaging* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging; D010496:Pericardium / Q000473:pathology* / Q000503:physiopathology; D012306:Risk
chemical_list: D019380:Anti-HIV Agents; D015415:Biomarkers; D002118:Calcium
references: AIDS. 2011 Jun 1;25(9):1199-205
references: 21505301
references: Am Heart J. 2007 Jun;153(6):907-17
references: 17540190
references: JAMA. 2004 Jan 14;291(2):210-5
references: 14722147
references: HIV Med. 2009 Feb;10(2):79-87
references: 19200170
references: AIDS. 2009 Sep 10;23(14):1841-9
references: 19455012
references: Circulation. 1998 Feb 17;97(6):535-43
references: 9494023
references: Heart. 2004 Nov;90(11):1286-90
references: 15486123
references: Atherosclerosis. 2008 Feb;196(2):720-6
references: 17275008
references: Ann Intern Med. 2006 Sep 19;145(6):397-406
references: 16983127
references: Eur J Cardiovasc Prev Rehabil. 2010 Oct;17(5):491-501
references: 20543702
references: Clin Physiol Funct Imaging. 2007 May;27(3):173-9
references: 17445068
references: AIDS. 2010 Jan 16;24(2):243-53
references: 19996940
references: J Acquir Immune Defic Syndr. 2010 Dec;55(4):495-9
references: 20720497
references: Eur Heart J. 2013 Aug;34(30):2368-80
references: 23186808
references: J Am Coll Cardiol. 1990 Mar 15;15(4):827-32
references: 2407762
references: PLoS One. 2011;6(7):e22698
references: 21799935
references: Atherosclerosis. 2010 Apr;209(2):573-8
references: 19892354
references: Atherosclerosis. 2010 May;210(1):150-4
references: 20031133
references: Clin Infect Dis. 2007 Jun 15;44(12):1625-31
references: 17516408
references: Lancet. 2010 Jan 9;375(9709):132-40
references: 20031199
references: AIDS. 2010 May 15;24(8):1228-30
references: 20400883
references: HIV Med. 2009 Nov;10(10):627-33
references: 19891054
references: AIDS. 2008 Aug 20;22(13):1615-24
references: 18670221
references: Eur Heart J. 2008 Mar;29(6):777-83
references: 18156138
references: BMC Med. 2004 Aug 24;2:31
references: 15327691
references: AIDS. 2005 Apr 29;19(7):729-31
references: 15821400
references: N Engl J Med. 2003 Nov 20;349(21):1993-2003
references: 14627784
references: JAMA. 2001 May 16;285(19):2486-97
references: 11368702
references: J Atheroscler Thromb. 2005;12(6):295-300
references: 16394610
references: Atherosclerosis. 2001 Jul;157(1):203-9
references: 11427222
references: J Nucl Cardiol. 2004 Mar-Apr;11(2):171-85
references: 15052249
references: AIDS. 2007 May 31;21(9):1137-45
references: 17502724
references: J Am Coll Cardiol. 1998 Jan;31(1):126-33
references: 9426030
references: AIDS. 2012 Jul 31;26(12):1573-6
references: 22713476
references: Eur Heart J. 1989 Oct;10(10):910-6
references: 2598948