Abstract 15148: HIV-infected Patients on Stable Antiretroviral Therapy Do Not Show Impaired Myocardial Flow Reserve Assessed With 82Rubidium PET/CT
Introduction: Epidemiological studies have shown that HIV-infected patients are at increased risk of coronary artery disease (CAD), and endothelial dysfunction has been suggested to play a pathogenetic role. Clinical studies of peripheral endothelial dysfunction find a higher prevalens among HIV-infected patients and some studies link these findings with the antiretroviral treatment (ART), especially abacavir. For the first time among HIV-infected patients, we assess the myocardial flow reserve (MFR) by 82Rb PET/CT, which can quantify endothelial function and thereby also detect small vessel disease. MFR has proved highly predictive of future CAD.
Hypothesis: We assessed the hypothesis that 82Rb PET/CT cardiac perfusion would reveal a decreased MFR among HIV-infected patients compared to healthy controls.
Methods: We conducted a cross-sectional study of 54 HIV-infected patients and 25 healthy controls using 82Rb PET/CT at rest and stress, thereby obtaining the MFR (stress flow/rest flow), which was stratified into low ≤ 2, borderline 2.1-2.5, and normal ≥ 2.5. Additionally, the coronary calcium score (CACS) was calculated.
Results: The HIV-infected patients had a median age of 53 years (IQR 46 - 59) and were all on stable ART with full viral suppression. The healthy controls had a median age of 53 (IQR 46 - 60). In the HIV-infected group 75% had a normal MFR, 14% had borderline and 11% low values of MFR. In the healthy control group these values were 76%, 12% and 12%, respectively (p = 0.95).
HIV-infected patients receiving abacavir did not show lower levels of MFR (p = 0.89). There was no difference in CACS between the two groups (median 0 (IQR 0 - 88) among HIV-infected and median 0 (0 - 14) among healthy controls, p = 0.20).
Conclusion: We found no evidence of decreased MFR among HIV-infected patients on stable ART with full viral suppression as assessed by 82Rb PET/CT, which may question the extent of endothelial dysfunction among optimally treated HIV-infected patients.
Author Disclosures: A. Knudsen: None. T. Christensen: None. A. Lebech: Research Grant; Modest; Abbott, Bristol-Myers Squibb, Gilead, Merck Sharp & Dohme, Glaxo Smith Kline Viif,, Boehringer Ingelheim and Janssen-Cilag. Honoraria; Modest; Abbott, Bristol-Myers Squibb, Gilead, Merck Sharp & Dohme, Glaxo Smith Kline Viif,, Boehringer Ingelheim and Janssen-Cilag. A. Kjær: None.
- © 2014 by American Heart Association, Inc.