Exploring the PREVENT HF score and myocardial function among persons with HIV

Abstract

Objective: Persons with HIV (PWH) are at risk for myocardial structural changes, which can progress to diastolic dysfunction and heart failure with preserved ejection fraction (HFpEF). We explored the AHA PREVENT HF (Predicting Risk of cardiovascular disease EVENTs for Heart Failure) risk score in relation to cardiac magnetic resonance (CMR) imaging.

Design: This cross-sectional study included 37 PWH on ART, ages 40-65, without known cardiovascular disease (CVD) who underwent CMR.

Methods: The risk score was assessed using the AHA PREVENT HF calculator. Scores were correlated to variables on CMR that are known indicators of subclinical myocardial dysfunction [left atrial volume index (LAVI), global longitudinal strain (GLS), and left ventricular mass index (LVMI)] and inflammation [extracellular volume (ECV) and longitudinal relaxation (T1)].

Results: PWH were age 55 (6) years [mean (SD)], predominantly male (76%) and white (57%) with BMI in the obese (≥30 kg/m 2 ) range: 31 (5) kg/m 2 . Median PREVENT HF score was 2.6 (1.4, 4.1)% [median (25th, 75th)]. The PREVENT HF score correlated to LAVI ( ρ = 0.35, P = 0.04), T1 ( ρ = 0.35, P = 0.04), interleukin (IL)-6 ( ρ = 0.36, P = 0.03) and NT-proBNP ( ρ = 0.42, P = 0.01). Risk scores were higher for those meeting clinical cutoffs LAVI >34 ml/m 2 and T1 ≥1250 ms. For predicting LAVI >34 ml/m 2 , a PREVENT HF score of 2.5 was the optimal cutoff [sensitivity 85%, specificity 65%, AUROC 0.769 ( P < 0.05)]. In predicting T1 ≥1250 ms, a PREVENT HF score of 3.6 was the optimal cutoff [71% sensitivity, 95% specificity, AUROC 0.727 ( P < 0.05)].

Conclusion: The PREVENT HF score related to indices of altered myocardial structure and inflammation among asymptomatic PWH with subclinical disease. These data begin to inform us about the utility of PREVENT HF score using radiographic findings, though more studies are needed among PWH to validate its use as a prediction tool.

Clinical trials registration: NCT02740179.

Keywords: HIV; PREVENT HF score; cardiac magnetic resonance imaging; cardiovascular disease; heart failure with preserved ejection fraction; myocardial disease.