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Mitral Annular and Coronary Artery Calcification Are Associated with Mortality in HIV-Infected Individuals.

Lange DC, Glidden D, Secemsky EA, Ordovas K, Deeks SG, Martin JN, Bolger AF, Hsue PY - PLoS ONE (2015)

Bottom Line: Subjects with CAC had significantly higher mortality compared to those with MAC only or no MAC.MAC, prior CVD, age and HIV viral load were independently associated with higher age- and gender-adjusted CAC percentiles in an adjusted model (p < 0.05 for all).In HIV patients, the presence of MAC, traditional risk factors and HIV viral load were independently associated with CAC.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.

ABSTRACT

Background: HIV infection increases cardiovascular risk. Coronary artery calcification (CAC) and mitral annular calcification (MAC) identify patients at risk for cardiovascular disease (CVD). The purpose of this study was to examine the association between MAC, CAC and mortality in HIV-infected individuals.

Methods and results: We studied 152 asymptomatic HIV-infected individuals with transthoracic echocardiography (TTE) and computed tomography (CT). MAC was identified on TTE using standardized criteria. Presence of CAC, CAC score and CAC percentiles were determined using the modified Agatston criteria. Mortality data was obtained from the Social Security and National Death Indices (SSDI/NDI). The median age was 49 years; 87% were male. The median duration of HIV was 16 years; 84% took antiretroviral therapy; 64% had an undetectable viral load. CVD risk factors included hypertension (35%), smoking (62%) and dyslipidemia (35%). Twenty-five percent of individuals had MAC, and 42% had CAC. Over a median follow-up of 8 years, 11 subjects died. Subjects with CAC had significantly higher mortality compared to those with MAC only or no MAC. The Harrell's C-statistic of CAC was 0.66 and increased to 0.75 when MAC was added (p = 0.05). MAC, prior CVD, age and HIV viral load were independently associated with higher age- and gender-adjusted CAC percentiles in an adjusted model (p < 0.05 for all).

Conclusion: In HIV patients, the presence of MAC, traditional risk factors and HIV viral load were independently associated with CAC. Presence of CAC and MAC may be useful in identifying HIV-infected individuals at higher risk for death.

No MeSH data available.


Related in: MedlinePlus

(A-B). MAC was defined as an echodense area visualized throughout systole and diastole, distinguishable from the posterior mitral valve leaflet, located anterior and parallel to the posterior left ventricular wall, seen here in the parasternal long axis view during diastole (A) and systole (B).Abbreviations: Right Ventricle (RV), Left Ventricle (LV), Aorta (Ao), Mitral Annular Calcification (MAC), Left Atrium (LA).
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pone.0130592.g001: (A-B). MAC was defined as an echodense area visualized throughout systole and diastole, distinguishable from the posterior mitral valve leaflet, located anterior and parallel to the posterior left ventricular wall, seen here in the parasternal long axis view during diastole (A) and systole (B).Abbreviations: Right Ventricle (RV), Left Ventricle (LV), Aorta (Ao), Mitral Annular Calcification (MAC), Left Atrium (LA).

Mentions: Standard two-dimensional (2D) echocardiography recordings were obtained in the parasternal, apical and subcostal views. M-mode recordings were performed in the parasternal long axis and apical four chamber views (GE Vivid 7, GE Healthcare, Milwaukee, Wisconsin). Raw data images were all interpreted off line (GE ECHOPac PC software) by a cardiologist (D.L.) to determine the presence or absence of MAC. The cardiologist interpreting the echocardiograms was blinded to all clinical information about the subjects. MAC was defined as the presence of an abnormally echo-dense area visualized throughout systole and diastole, distinguishable from the posterior mitral valve leaflet, located anterior and parallel to the posterior left ventricular wall, and visualized in at least two views (e.g. parasternal long axis view and apical four chamber view) (Fig 1A and 1B;Fig 2A and 2B). These diagnostic criteria are consistent with those used in previous studies [15,23,26]. If MAC was present using these criteria, three measurements from consecutive beats were taken in the parasternal long axis and apical four chamber views using the caliper tool, following a pre-specified protocol (Figs 3 and 4).


Mitral Annular and Coronary Artery Calcification Are Associated with Mortality in HIV-Infected Individuals.

Lange DC, Glidden D, Secemsky EA, Ordovas K, Deeks SG, Martin JN, Bolger AF, Hsue PY - PLoS ONE (2015)

(A-B). MAC was defined as an echodense area visualized throughout systole and diastole, distinguishable from the posterior mitral valve leaflet, located anterior and parallel to the posterior left ventricular wall, seen here in the parasternal long axis view during diastole (A) and systole (B).Abbreviations: Right Ventricle (RV), Left Ventricle (LV), Aorta (Ao), Mitral Annular Calcification (MAC), Left Atrium (LA).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4488486&req=5

pone.0130592.g001: (A-B). MAC was defined as an echodense area visualized throughout systole and diastole, distinguishable from the posterior mitral valve leaflet, located anterior and parallel to the posterior left ventricular wall, seen here in the parasternal long axis view during diastole (A) and systole (B).Abbreviations: Right Ventricle (RV), Left Ventricle (LV), Aorta (Ao), Mitral Annular Calcification (MAC), Left Atrium (LA).
Mentions: Standard two-dimensional (2D) echocardiography recordings were obtained in the parasternal, apical and subcostal views. M-mode recordings were performed in the parasternal long axis and apical four chamber views (GE Vivid 7, GE Healthcare, Milwaukee, Wisconsin). Raw data images were all interpreted off line (GE ECHOPac PC software) by a cardiologist (D.L.) to determine the presence or absence of MAC. The cardiologist interpreting the echocardiograms was blinded to all clinical information about the subjects. MAC was defined as the presence of an abnormally echo-dense area visualized throughout systole and diastole, distinguishable from the posterior mitral valve leaflet, located anterior and parallel to the posterior left ventricular wall, and visualized in at least two views (e.g. parasternal long axis view and apical four chamber view) (Fig 1A and 1B;Fig 2A and 2B). These diagnostic criteria are consistent with those used in previous studies [15,23,26]. If MAC was present using these criteria, three measurements from consecutive beats were taken in the parasternal long axis and apical four chamber views using the caliper tool, following a pre-specified protocol (Figs 3 and 4).

Bottom Line: Subjects with CAC had significantly higher mortality compared to those with MAC only or no MAC.MAC, prior CVD, age and HIV viral load were independently associated with higher age- and gender-adjusted CAC percentiles in an adjusted model (p < 0.05 for all).In HIV patients, the presence of MAC, traditional risk factors and HIV viral load were independently associated with CAC.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.

ABSTRACT

Background: HIV infection increases cardiovascular risk. Coronary artery calcification (CAC) and mitral annular calcification (MAC) identify patients at risk for cardiovascular disease (CVD). The purpose of this study was to examine the association between MAC, CAC and mortality in HIV-infected individuals.

Methods and results: We studied 152 asymptomatic HIV-infected individuals with transthoracic echocardiography (TTE) and computed tomography (CT). MAC was identified on TTE using standardized criteria. Presence of CAC, CAC score and CAC percentiles were determined using the modified Agatston criteria. Mortality data was obtained from the Social Security and National Death Indices (SSDI/NDI). The median age was 49 years; 87% were male. The median duration of HIV was 16 years; 84% took antiretroviral therapy; 64% had an undetectable viral load. CVD risk factors included hypertension (35%), smoking (62%) and dyslipidemia (35%). Twenty-five percent of individuals had MAC, and 42% had CAC. Over a median follow-up of 8 years, 11 subjects died. Subjects with CAC had significantly higher mortality compared to those with MAC only or no MAC. The Harrell's C-statistic of CAC was 0.66 and increased to 0.75 when MAC was added (p = 0.05). MAC, prior CVD, age and HIV viral load were independently associated with higher age- and gender-adjusted CAC percentiles in an adjusted model (p < 0.05 for all).

Conclusion: In HIV patients, the presence of MAC, traditional risk factors and HIV viral load were independently associated with CAC. Presence of CAC and MAC may be useful in identifying HIV-infected individuals at higher risk for death.

No MeSH data available.


Related in: MedlinePlus