Abstract 14110: Mitral Annular Calcification and Coronary Artery Calcification are Associated With Mortality in HIV-Infected Individuals
Background: Coronary artery calcification (CAC) identifies patients at risk for cardiovascular disease (CVD). Mitral annular calcification (MAC) on transthoracic echocardiography (TTE) correlates with CAC. The purpose of this study was to examine the association between MAC and CAC and to understand their relation to mortality in HIV-infected individuals.
Methods: We studied 152 asymptomatic HIV-infected individuals with TTE and computed tomography (CT). MAC was defined as an echodense band on TTE located anterior and parallel to the posterior LV wall throughout the cardiac cycle, distinguishable from the posterior mitral valve leaflet. Presence of CAC, CAC score and CAC percentiles were determined using the modified Agatston criteria. Mortality data was obtained from the SSDI/NDI.
Results: The median age was 49 years (IQR 44 to 55); 87% were male. The median duration of HIV infection was 16 years, 84% were on antiretroviral therapy, 64% had an undetectable viral load. CVD risk factors included hypertension (35%), smoking (62%) and dyslipidemia (35%). Using TTE, 25% of individuals had MAC. Subjects with and without MAC had similar HIV and traditional risk factors except for family history of CVD (8% in those with MAC vs. 26% in those without, p = 0.02). On CT, 42% of patients had CAC. Over a median follow-up period of 8 years (988 person-yrs), 11 subjects died (1.11 / 100 person-yrs). Subjects with CAC had significantly higher mortality compared to those without, or those with only MAC (2.88 / 100 person-yrs in the CAC group vs. 1.86 in the MAC group vs. 0.20 in the control group, p = 0.01). The Harrel’s C-statistic for CAC was 0.66 and increased to 0.75 when MAC was added (comparison p = 0.05). After adjustment for HIV characteristics and traditional risk factors, the presence of MAC, prior CVD, age and HIV viral load were all independently associated with higher age- and gender-adjusted CAC percentiles (p < 0.05 for all).
Conclusion: In HIV patients, the presence of MAC, traditional risk factors and HIV viral load were all independently associated with CAC. These findings suggest that control of HIV infection may contribute to both CAC and increased risk of CVD. Presence of MAC in addition to CAC may be useful in identifying HIV-infected individuals at higher risk for death.
- © 2013 by American Heart Association, Inc.