Exercise-Induced Pulmonary Hypertension Is Associated with High Cardiovascular Risk in Patients with HIV

Abstract

Background and Aim: Pulmonary hypertension (PH) at rest can be preceded by the onset of exercise-induced PH (ExPH). We investigated its association with the cardiovascular (CV) risk score in patients with human immunodeficiency virus (HIV). Methods: In 46 consecutive patients with HIV with low (n = 43) or intermediate (n = 3) probability of resting PH, we evaluated the CV risk score based on prognostic determinants of CV risk. Diagnosis of ExPH was made by cardiopulmonary exercise test (CPET) and exercise stress echocardiogram (ESE). Results: Twenty-eight % (n = 13) of the enrolled patients had ExPH at both CPET and ESE, with good agreement between the two methods (Cohen’s kappa = 0.678). ExPH correlated directly with a higher CV score (p < 0.001). Patients with a higher CV score also had lower CD4+ T-cell counts (p = 0.001), a faster progression to acquired immunodeficiency syndrome (p < 0.001), a poor immunological response to antiretroviral therapy (p = 0.035), higher pulmonary vascular resistance (p = 0.003) and a higher right atrial area (p = 0.006). Conclusions: Isolated ExPH is associated with a high CV risk score in patients with HIV. Assessment of ExPH may better stratify CV risk in patients with HIV.

Keywords: acquired immunodeficiency syndrome; cardiovascular risk; exercise cardiopulmonary test; exercise stress echocardiography; exercise-induced pulmonary hypertension.

Figure 1

Concordance of exercise stress echocardiography and the cardiopulmonary exercise test in the diagnosis of isolated exercise pulmonary hypertension. Abbreviations: ESE, exercise stress echocardiogram; ExPH, exercise-induced pulmonary hypertension; CPET, cardiopulmonary exercise test.