title: Normal Myocardial Flow Reserve in HIV-Infected Patients on Stable Antiretroviral Therapy: A Cross-Sectional Study Using Rubidium-82 PET/CT.
abstract: 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.
authors.affiliation: From the Department of Infectious Diseases (AK, A-ML), Copenhagen University Hospital, Hvidovre; and Department of Clinical Physiology, Nuclear Medicine & PET, and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark. (AK, TEC, AAG, PH, AK, RSP).
authors.forename: Andreas
authors.initials: A
authors.lastname: Knudsen
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Christensen
authors.forename: Adam Ali
authors.initials: AA
authors.lastname: Ghotbi
authors.forename: Philip
authors.initials: P
authors.lastname: Hasbak
authors.forename: Anne-Mette
authors.initials: AM
authors.lastname: Lebech
authors.forename: Andreas
authors.initials: A
authors.lastname: Kjær
authors.forename: Rasmus Sejersten
authors.initials: RS
authors.lastname: Ripa
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D003326:Coronary Circulation; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D012414:Rubidium Radioisotopes; D013318:Stroke Volume
chemical_list: D044966:Anti-Retroviral Agents; D012414:Rubidium Radioisotopes