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

  • Denis Mariano-Goulart
  • Jean-Marc Jacquet
  • Nicolas Molinari
  • Aurélie Bourdon
  • Meriem Benkiran
  • Mélanie Sainmont
  • Luc Cornillet
  • Jean-Christophe Macia
  • Jacques Reynes
  • Fayçal Ben Bouallègue
Original Article

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.

Keywords

AIDS HIV infection Silent myocardial ischaemia Gated SPECT Myocardial perfusion 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Denis Mariano-Goulart
    • 1
    • 5
  • Jean-Marc Jacquet
    • 2
  • Nicolas Molinari
    • 3
  • Aurélie Bourdon
    • 1
  • Meriem Benkiran
    • 1
  • Mélanie Sainmont
    • 1
  • Luc Cornillet
    • 4
  • Jean-Christophe Macia
    • 4
  • Jacques Reynes
    • 2
  • Fayçal Ben Bouallègue
    • 1
  1. 1.Department of Nuclear MedicineMontpellier University HospitalMontpellierFrance
  2. 2.Department of Infectious and Tropical DiseasesMontpellier University HospitalMontpellierFrance
  3. 3.Department of Statistics and EpidemiologyMontpellier University HospitalMontpellierFrance
  4. 4.Department of CardiologyMontpellier University HospitalMontpellierFrance
  5. 5.Département de Médecine NucléaireCentre Hospitalier Universitaire LapeyronieMontpellier Cedex 5France

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