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Stress Echocardiography Predictive of Heart Attack or Death in HIV Patients

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Abnormal results on a stress echocardiogram in HIV patients with known or suspected heart disease predict dramatically higher risk of heart attack or cardiac death. (Image courtesy: Wikipedia, taken by Kjetil Lenes)HIV patients with abnormal results on a ultrasound stress test have nearly a 10 times higher risk of a heart attack or cardiac death than the normal population, and more than three times the risk of people without HIV who have an abnormal stress echocardiogram a new study shows.

Senior author of the study, Dr. Farooq Chaudhry, associate professor of medicine, and colleagues at Columbia University College of Physicians and Surgeons in New York City performed stress echo tests on 311 HIV patients with suspected or known heart disease. They reported their findings online before the July 12, 2011 print issue of Circulation: Cardiovascular Imaging.

The researchers looked at whether stress echo can help predict risk of heart attack and death in a high-risk population, in this case HIV patients with known or suspected heart disease. HIV infection and the drugs used to treat it have been associated with accelerated coronary artery disease and cardiovascular events in prior research. While stress echocardiography is an accepted method of diagnosis, risk evaluation and prognosis of coronary artery disease, its prognostic value in HIV-positive patients is unknown.

"Although we did not study which treatments are most effective for these patients, HIV patients who have abnormal stress echocardiography should probably be monitored and treated more aggressively to prevent heart attack and death," said Chaudhry in a prepared statement. "Conversely, patients with a normal stress echo might not need such aggressive interventions."

The 311 patients studied were an average of 52 years old, and 80 of them (26 percent) had an abnormal stress echo. During the average 2.9-year follow-up, 17 experienced nonfatal heart attacks and 14 died of cardiac causes.

When they analyzed the data they found that the prognosis for HIV patients who had normal stress was good. The average risk for these patients was 1 percent per year, the same as that for the general healthy population.

The risk of cardiac death or myocardial infarction rose dramatically for HIV patients with an abnormal stress echo test result. Their average annual risk was nearly 12 percent per year, 10 times higher than the average for the normal population and nearly three times higher than the non-HIV population with abnormal stress echo results.

Similarly 100 percent of HIV patients with normal stress echo survived at one year and 98 percent at four years, which is in stark contrast to HIV patients with an abnormal stress echo test. For these patients 92 percent survived at one year but that number dropped dramatically to 62 percent at four years.

The researchers noted that limitations of the study include the subjective nature of interpreting stress echocardiography, which may limit the study's application to centers with more experience. In addition, the results of the test may have influenced management of the patients, including referral for revascularization, they noted.

By Michael O’Leary, contributing writer, Health Imaging Hub

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