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Should HIV-infected patients be screened for silent myocardial ischaemia using gated myocardial perfusion SPECT?

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

A higher prevalence of cardiovascular risk factors (CRFs) in HIV-infected patients, together with chronic infection and treatments, has resulted in an increased risk of silent myocardial ischaemia (SMI). The objective of this study was to evaluate whether myocardial SPECT should be used for screening HIV-infected patients with no clinical symptoms of coronary artery disease.

Methods

The prevalence of SMI detected by myocardial SPECT was determined in 94 HIV-infected patients with a normal clinical cardiovascular examination in relation to anthropomorphic parameters, CRFs, inflammatory and HIV infection status, and treatment.

Results

Coronary artery disease was detected in nine patients (eight with ischaemia, one with myocardial infarction), corresponding to 9.6 % positivity. All but two of the scintigraphic diagnoses of ischaemia were confirmed by coronarography. Univariate analysis revealed that the overall number of CRFs and the combination of gender and age were associated with a diagnosis of SMI (p < 0.05). According to multivariate analysis, the only independent parameter significantly associated with the scintigraphic diagnosis of SMI was the combination of gender and age (p = 0.01). All the positive myocardial SPECT scans were in men older than 52 years with at least two other CRFs. In this subpopulation of 47 patients, the prevalence of SMI detected by myocardial SPECT reached 19.2 %.

Conclusion

In male HIV-infected patients older than 52 years and with at least two other CRFs, screening for SMI using myocardial SPECT was about four times more likely to be positive than in the general population. This may motivate physicians to advise these patients to undergo more systematic screening for SMI using this technique.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Montpellier University Hospital, Montpellier, France

    Denis Mariano-Goulart, Aurélie Bourdon, Meriem Benkiran, Mélanie Sainmont & Fayçal Ben Bouallègue

  2. Department of Infectious and Tropical Diseases, Montpellier University Hospital, Montpellier, France

    Jean-Marc Jacquet & Jacques Reynes

  3. Department of Statistics and Epidemiology, Montpellier University Hospital, Montpellier, France

    Nicolas Molinari

  4. Department of Cardiology, Montpellier University Hospital, Montpellier, France

    Luc Cornillet & Jean-Christophe Macia

  5. Département de Médecine Nucléaire, Centre Hospitalier Universitaire Lapeyronie, 371, avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France

    Denis Mariano-Goulart

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  1. Denis Mariano-Goulart
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Correspondence to Denis Mariano-Goulart.

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Mariano-Goulart, D., Jacquet, JM., Molinari, N. et al. Should HIV-infected patients be screened for silent myocardial ischaemia using gated myocardial perfusion SPECT?. Eur J Nucl Med Mol Imaging 40, 271–279 (2013). https://doi.org/10.1007/s00259-012-2262-1

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  • DOI: https://doi.org/10.1007/s00259-012-2262-1

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