Association of Coronary Wall Thickening and Diminished Diastolic Function in Asymptomatic, Low Cardiovascular Disease-Risk Persons Living with HIV

Abstract

Purpose To assess early subclinical coronary artery disease (CAD) burden and its relation to myocardial function in asymptomatic persons living with HIV (PLWH) who are at low risk for cardiovascular disease (CVD). Materials and Methods In this prospective, HIPAA-compliant study (ClinicalTrials.gov NCT01656564 and NCT01399385) conducted from April 2010 to May 2013, 74 adult PLWH without known CVD and 25 matched healthy controls underwent coronary MRI to measure coronary vessel wall thickness (VWT) and echocardiography to assess left ventricular function. Univariable and multivariable linear regression analyses were used to evaluate statistical associations. Results For PLWH, the mean age was 49 years ± 11 (SD), and the median Framingham risk score was 3.2 (IQR, 0.5-6.6); for matched healthy controls, the mean age was 46 years ± 8 and Framingham risk score was 2.3 (IQR, 0.6-6.1). PLWH demonstrated significantly greater coronary artery VWT than did controls (1.47 mm ± 0.22 vs 1.34 mm ± 0.18; P = .006) and a higher left ventricular mass index (LVMI) (77 ± 16 vs 70 ± 13; P = .04). Compared with controls, PLWH showed altered association between coronary artery VWT and both E/A (ratio of left ventricular-filling peak blood flow velocity in early diastole [E wave] to that in late diastole [A wave]) (P = .03) and LVMI (P = .04). In the PLWH subgroup analysis, coronary artery VWT increase was associated with lower E/A (P < .001) and higher LVMI (P = .03), indicating restricted diastolic function. In addition, didanosine exposure was associated with increased coronary artery VWT and decreased E/A ratio. Conclusion Asymptomatic low-CVD-risk PLWH demonstrated increased coronary artery VWT in association with impaired diastolic function, which may be amenable to follow-up studies of coronary pathogenesis to identify potential effects on the myocardium and risk modification strategies. Keywords: Coronary Vessel Wall Thickness, Diastolic Function, HIV, MRI, Echocardiography, Atherosclerosis Clinical trial registration nos. NCT01656564 and NCT01399385 Supplemental material is available for this article. © RSNA, 2024.

Keywords: Atherosclerosis; Coronary Vessel Wall Thickness; Diastolic Function; Echocardiography; HIV; MRI.

Graphical abstract

Figure 1:

Flow diagram shows initial number of participants, final numbers, and reasons for exclusion. CorVWT = coronary vessel wall thickness, PLWH = persons living with HIV.

Figure 2:

MR angiograms (top row) of the right coronary arteries in two persons living with HIV (PLWH) show location of cross-section (dotted lines) of coronary vessel wall image (bottom row) and the corresponding automatic wall thickness measurement. (A) Image from 50-year-old male PLWH with increased coronary vessel wall thickness of 1.5 mm and grade 1 diastolic dysfunction. (B) Image from 52-year-old male PLWH with coronary vessel wall thickness of 1.2 mm and normal diastolic function.

Figure 3:

Scatterplots, means, and SDs of coronary artery vessel wall thickness (CorVWT), E/A (ratio of left ventricular–filling peak blood flow velocity in early diastole [the E wave] to that in late diastole [the A wave]), and left ventricular mass index (LVMI) in persons living with HIV (PLWH) and the control groups. Red dots in the leftmost plot indicate PLWH with diastolic dysfunction. * P < .05.

Figure 4:

Demonstration of all cohort multiple regression results in Table 3. Top row: Association between coronary artery vessel wall thickness (CorVWT) and age in the control group (green) and the effect of HIV infection (blue) and diabetes (red). Middle row: Relation between E/A (ratio of left ventricular–filling peak blood flow velocity in early diastole (the E wave) to that in late diastole (the A wave) and age in the control group at CorVWT of 1.35 mm (green), in persons living with HIV (PLWH) at the same CorVWT (red), and in PLWH with a thicker CorVWT of 1.65 (black). Bottom: Left ventricular mass index (LVMI) versus Framingham risk score (FRS) in controls at CorVWT of 1.35 mm (black), in PLWH at the same thickness (red), and in PLWH at CorVWT of 1.65 mm (black). The correlation between the years of HIV infection and CorVWT was deemed nonsignificant. Relationships are shown at the mean value of years of HIV infection.