RESUMEN
BACKGROUND: HIV infection is a global public health issue that is frequently associated with cardiac involvement. However, myocardial dysfunction and heart failure are often clinically occult or attributed incorrectly to other non-cardiac disease processes even a heightened awareness and knowledge for these cardiac diseases in HIV-infected patients may lead to earlier detection and a reduction in morbidity and mortality. The present study evaluates the frequency and clinical course of myocardial dysfunction and heart failure in a HIV-infected population. METHODS: The HIV-HEART (HIV-infection and HEART disease) study is a prospective, long-term cohort study. The study is designed and powered to define prevalence and natural history of chronic heart failure. Following a pilot-study of 105 HIV-infected subjects the HIV-HEART trial will contain 802 HIV-infected males and females with and without antiretroviral therapy in an urban population. HIV-HEART is performed by using non-invasive techniques for the quantification of exercise intolerance and ventricular dysfunction, including concentration of B-type natriretic peptide (BNP), transthoracal echocardiography and endurance testing. Patients with BNP >100 pg/ml achieve a magnetic resonance tomography of the heart for characterization of myocardial dysfunction and type of cardiomyopathy. To determine incidence and natural history of myocardial dysfunction and heart failure, a 2 year follow-up started in September 2006. CONCLUSIONS: The HIV-HEART study will define the significance of myocardial dysfunction and heart failure in a HIV-infected urban population and classify appropriate methods for identifying high-risk patients, the basis for risk stratification and therapy.
Asunto(s)
Gasto Cardíaco Bajo/diagnóstico , Gasto Cardíaco Bajo/epidemiología , Infecciones por VIH/complicaciones , Determinación de la Presión Sanguínea , Ecocardiografía , Electrocardiografía , Femenino , Humanos , Masculino , PrevalenciaRESUMEN
BACKGROUND: This report presents population-based estimates of the prevalence of peripheral arterial disease (PAD), chronic critical limb ischemia (CLI), and Moenckeberg's medial calcinosis (MC) in Germany. PATIENTS AND METHODS: From the year 2000 to 2003, a total of 4,814 subjects aged 45-75 years were included in the study. In 30 of the subjects (0.6%), determination of the ankle brachial index (ABI) was not possible, leaving 4,735 subjects (99.4%) in the data set. PAD was considered present in all subjects with an ABI < 0.9 in one leg, and/or a history of prior treatment for PAD. CLI was considered present if the highest ankle artery pressure measured < 70 mmHg. Prevalence of MC was calculated for ABI cut-off values of 1.3 and 1.5. FINDINGS: The overall prevalence of PAD according to the ABI criteria was 6.4% among men and 5.1% among women. After accounting for history of PAD, the prevalence increased to 8.2% among men and 5.5% among women. Taking the ABI criteria and medical history into account, males had a higher prevalence of PAD, with large increases in males aged 65-69 and 70-75 years. Chronic CLI was rare in the investigated population, and was found in only five older subjects (0.1%). With the criterion of ABI > 1.3, about 13.3% of males and 6.9% of females had MC. In contrast to PAD, the prevalence of MC did not increase with age. With the criterion of ABI > 1.5, MC was present in only 1.1% and 0.5% of men and women, respectively, but only 30 (0.6%) subjects had incompressible ankle arteries with a cuff pressure > 260 mmHg. CONCLUSION: Prevalences of PAD based only on ABI generally underestimate the true prevalence of PAD in population-based studies. CLI predominantly affects older subjects. In addition, cut-off values for MC must be newly determined.
Asunto(s)
Isquemia/epidemiología , Enfermedades Vasculares Periféricas/epidemiología , Anciano , Tobillo/irrigación sanguínea , Presión Sanguínea , Arteria Braquial/fisiopatología , Estudios de Cohortes , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Esclerosis Calcificante de la Media de Monckeberg/epidemiología , Prevalencia , Estudios ProspectivosRESUMEN
HIV infection is frequently associated with cardiovascular involvement. Particularly new treatment concepts, including the highly active antiretroviral therapy, are suspected to increase the rate of cardiac and cardiovascular complications in this patient population. Hence, noninvasive techniques such as transthoracic echocardiography and magnetic resonance imaging will become more important in the routine screening as well as in specific diagnostics of cardiovascular involvement of HIV infection. The present article describes the options of these noninvasive techniques for the detection of HIV-associated cardiac manifestations.
Asunto(s)
Ecocardiografía/métodos , Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico , Cardiopatías/diagnóstico , Cardiopatías/etiología , Imagen por Resonancia Magnética/métodos , Humanos , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en MedicinaRESUMEN
The use of highly antiretroviral therapy (HAART) significantly reduced morbidity and mortality by inhibition of virus replication. Even though long-term side effects are not fully known, this antiviral strategy has revolutionized the care of HIV-infected patients and is widely used in industrial countries. Until now, a variety of metabolic side effects, such as hyperlipidemia and insulin resistance, have been described. These metabolic alterations of antiretroviral therapy increase the cardiovascular risk profile of HIV-infected patients. It could be expected, that the increased cardiovascular risk profile in combination with long-term survival of this patient population, will increase the diagnostics and therapy of coronary diseases of HIVinfected patients in the next years. The present article (1) contains the case report of a 39-year-old HIV-infected male with an acute myocardial infarction, and (2) gives an overview about arteriosclerosis and coronary events in HIV-infected patients and the impact of antiretroviral therapy.
Asunto(s)
Fármacos Anti-VIH/efectos adversos , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa/efectos adversos , Enfermedad Coronaria/inducido químicamente , Enfermedad Coronaria/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Infarto del Miocardio/inducido químicamente , Infarto del Miocardio/diagnóstico , Adulto , Infecciones por VIH/complicaciones , Humanos , Masculino , Resultado del TratamientoRESUMEN
Human immunodeficiency virus (HIV) infection is a global public health issue that is frequently associated with cardiovascular involvement. Left ventricular dysfunction, an independent predictor of mortality in HIV-infected patients, is the result of many causes in this population and may result in dilated cardiomyopathy and congestive heart failure in about 10% of patients. Antiinfective and highly active antiretroviral therapies may be particularly helpful in this population to reduce HIV-associated diseases. However, some of these drugs exhibit mitochondrial toxicity being expected to impair myocardial function. The HIV-associated cardiomyopathy is often clinically occult or attributed incorrectly to other noncardiac disease processes. Therefore, a heightened awareness and routine screening for cardiovascular involvement in HIV-infected patients would lead to earlier detection and the hope for a reduction in associated morbidity and mortality. In summary, cardiovascular complications, particular HIV-associated cardiomyopathy, are important contributors to morbidity and mortality in HIV-infected patients that can be detected early in many cases and may be treated effectively. The therapy of HIV-associated cardiomyopathy comprises standard medical treatment for heart failure.