Abstract 14570: Risk Stratification of Patients with HIV and Renal Dysfunction Undergoing Stress Echocardiographic Evaluation for Known or Suspected Coronary Artery Disease
Background: HIV affects both the heart and kidneys, resulting in a substantial increase in overall morbidity and mortality. However, the impact of renal function on cardiovascular events in patients with HIV is not well defined. Furthermore, the role of stress echocardiography (SE) in the risk stratification and prognostication of patients with HIV and renal dysfunction is unknown.
Methods: 329 patients with HIV (mean age 52±9.3 years; 74% males) were referred for SE (56% dobutamine). Estimated glomerular filtration rate (eGFR) was calculated with the 4-variable modified diet in renal disease “MDRD” equation: GFR (ml/min/1.73 m2) = 175 x (Scr)-1.154 x (Age)-0.203 x 0.742 (if female) x 1.210 (if African American). The presence of chronic kidney disease (CKD) was defined with the National Kidney foundation definition of an eGFR <60 ml/min/1.73 m2. An abnormal SE was defined by a peak wall motion score index (PWMSI) >1. Follow up (2.8 ±1.9 years) for myocardial infarction and cardiac death was obtained.
Results: CKD was present in 18% of the patients. During follow up 32 hard events occurred. The event rate in patients with CKD was 2.3 times higher than patients with normal renal function (event rate 8.5%/year vs. 2.4%/year, p<0.0001). For every 10 mL/min/1.73 m2 decrease in eGFR, the risk of cardiovascular events increased by 22% (OR 1.02, CI 1.01-1.03, p<0.0001). SE effectively risk stratified patients with HIV with and without renal dysfunction (Figure). After adjustment for age, CKD, LVEF, and SE results, only the presence of scar and ischemia as determined by an abnormal SE (HR 10.6, CI 3.4-32.1, p<0.0001) and LVEF (HR 0.97, CI 0.95-0.98, p=0.001) were significant predictors of cardiac events.
Conclusion: CKD is common in patients with HIV and portends a poor prognosis. Stress echocardiography effectively risk stratifies patients with HIV and CKD.
- © 2011 by American Heart Association, Inc.