Abstract 13232: Right Ventricular Function is a Strong Prognosticator in Patients With HIV Referred for Stress Echocardiography
Background: Right ventricular (RV) wall motion abnormalities on stress echocardiography (SE) have independent and incremental prognostic value over left ventricular (LV) wall motion abnormalities in patients with known or suspected coronary artery disease. However, the role of RV wall motion abnormalities in patients with HIV, who are at increased risk of cardiovascular events, is unknown.
Methods: 329 HIV patients (mean age 52±9.3 years; 74% males; mean LVEF 54%±12) were referred for SE (56% dobutamine). An abnormal RV or LV was defined as one with new, biphasic (ischemic) or fixed (infarction) wall motion abnormalities post-stress. Follow up (2.8 ±1.9 years) for myocardial infarction and cardiac death was obtained.
Results: An abnormal RV was seen in 14 patients (4.3%). Only 1 patient had an abnormal RV in the presence of a normal LV. During follow up 32 hard events occurred. The event rate in patients with an abnormal RV in the presence of an abnormal LV was 2.6 times higher than patients with a normal RV and abnormal LV (event rate 24.7%/year vs. 9.46%/year, p=0.006)(Figure). On univariate analysis, age (HR 1.04, 95%CI 1.01–1.08, p=0.006), LVEF (HR 0.94, 95%CI 0.92–0.95, p<0.0001), abnormal LV (HR 16, 95%CI 6.2–41.9, p<0.0001), number of LV ischemic segments (HR 1.2, 95%CI 1.1–1.3, p<0.0001) and abnormal RV (HR 23.4, 95%CI 10–54, p<0.0001) were predictors of cardiac events. After adjustment only the presence of an abnormal LV (HR 8.7, 95%CI 2.6–29, p=0.001) and abnormal RV (HR 6.8, 95%CI 1.3–36, p=0.02) were significant predictors of cardiac events.
Conclusions: In HIV infected patients referred for SE, RV function provides independent prognostic value. In the presence of stress induced LV ischemia, RV dysfunction portends the worst prognosis.
- © 2010 by American Heart Association, Inc.