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. 2014 Jun 1;66(2):164-71.
doi: 10.1097/QAI.0000000000000138.

Increased arterial inflammation relates to high-risk coronary plaque morphology in HIV-infected patients

Ahmed Tawakol  1 , Janet Lo, Markella V Zanni, Eleni Marmarelis, Ezinne J Ihenachor, Megan MacNabb, Bryan Wai, Udo Hoffmann, Suhny Abbara, Steven Grinspoon
Affiliations

Increased arterial inflammation relates to high-risk coronary plaque morphology in HIV-infected patients

Ahmed Tawakol et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Mechanisms predisposing HIV-infected patients to increased cardiovascular disease (CVD) risk remain unclear.

Objective: To determine the interrelationship between arterial inflammation and high-risk coronary plaque morphology in HIV-infected patients with subclinical coronary atherosclerosis.

Methods: Forty-one HIV-infected patients on stable antiretroviral therapy without known CVD but with atherosclerotic plaque on coronary CT angiography were evaluated with F-FDG-PET. Patients were stratified into 2 groups based on relative degree of arterial inflammation [aortic target-to-background ratio (TBR)]. High-risk coronary atherosclerotic plaque morphology features were compared between groups.

Results: HIV-infected patients with higher and lower TBRs were similar with respect to traditional CVD risk parameters. Among HIV-infected patients with higher TBR, an increased percentage of patients demonstrated at least 1 low-attenuation coronary atherosclerotic plaque (40% vs. 10%, P = 0.02) and at least 1 coronary atherosclerotic plaque with both low attenuation and positive remodeling (35% vs. 10%, P = 0.04). Moreover, in the higher TBR group, both the number of low-attenuation plaques per patient (P = 0.02) and the number of vulnerability features in the most vulnerable plaque (P = 0.02) were increased. TBR grouping remained significantly related to the number of low-attenuation plaques/subject (β = 0.35, P = 0.004), controlling for age, gender, low-density lipoprotein, duration of HIV, and CD4.

Conclusions: These data demonstrate a relationship between arterial inflammation on F-FDG-PET and high-risk coronary atherosclerotic plaque features among HIV-infected patients with subclinical coronary atherosclerosis. Further studies are needed to determine whether arterial inflammation and related high-risk coronary morphology increase the risk of clinical CVD events in the HIV population.

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Figures

Figure 1
Figure 1
Panel A. Representative 18F-FDG-PET image from a subject with increased (2.36) aortic target to background ratio (TBR) demonstrated on coronal imaging. Panels B and C. Representative coronary computed tomography (CTA) long-axis (B) and short-axis (C) images in the same subject as Panel A, demonstrating a low attenuation, positively remodelled plaque with spotty calcification in the mid right coronary. The diameter measurements at the plaque (yellow line) and at distal normal reference segment (black line) are shown for the determination of remodeling index. Short axis image is at level of plaque.
Figure 2
Figure 2
Comparison of percent of subjects with at least one low attenuation coronary atherosclerotic plaque and comparison of percent of subjects with at least one coronary atherosclerotic plaque characterized by both low attenuation and positive remodeling among HIV-infected subjects with aortic TBR (a measure of arterial inflammation) above and below the group median.
See this image and copyright information in PMC

References

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