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. 2015 Jul 1;10(7):e0130592.
doi: 10.1371/journal.pone.0130592. eCollection 2015.

Mitral Annular and Coronary Artery Calcification Are Associated With Mortality in HIV-Infected Individuals

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Free PMC article

Mitral Annular and Coronary Artery Calcification Are Associated With Mortality in HIV-Infected Individuals

David C Lange et al. PLoS One. .
Free PMC article

Abstract

Background: HIV infection increases cardiovascular risk. Coronary artery calcification (CAC) and mitral annular calcification (MAC) identify patients at risk for cardiovascular disease (CVD). The purpose of this study was to examine the association between MAC, CAC and mortality in HIV-infected individuals.

Methods and results: We studied 152 asymptomatic HIV-infected individuals with transthoracic echocardiography (TTE) and computed tomography (CT). MAC was identified on TTE using standardized criteria. Presence of CAC, CAC score and CAC percentiles were determined using the modified Agatston criteria. Mortality data was obtained from the Social Security and National Death Indices (SSDI/NDI). The median age was 49 years; 87% were male. The median duration of HIV was 16 years; 84% took antiretroviral therapy; 64% had an undetectable viral load. CVD risk factors included hypertension (35%), smoking (62%) and dyslipidemia (35%). Twenty-five percent of individuals had MAC, and 42% had CAC. Over a median follow-up of 8 years, 11 subjects died. Subjects with CAC had significantly higher mortality compared to those with MAC only or no MAC. The Harrell's C-statistic of CAC was 0.66 and increased to 0.75 when MAC was added (p = 0.05). MAC, prior CVD, age and HIV viral load were independently associated with higher age- and gender-adjusted CAC percentiles in an adjusted model (p < 0.05 for all).

Conclusion: In HIV patients, the presence of MAC, traditional risk factors and HIV viral load were independently associated with CAC. Presence of CAC and MAC may be useful in identifying HIV-infected individuals at higher risk for death.

Conflict of interest statement

Competing Interests: P.Y.H. has received honoraria from Gilead and Pfizer. There was no relationship with Gilead, Pfizer or any other industry member in supporting this study. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. (A-B). MAC was defined as an echodense area visualized throughout systole and diastole, distinguishable from the posterior mitral valve leaflet, located anterior and parallel to the posterior left ventricular wall, seen here in the parasternal long axis view during diastole (A) and systole (B).
Abbreviations: Right Ventricle (RV), Left Ventricle (LV), Aorta (Ao), Mitral Annular Calcification (MAC), Left Atrium (LA).
Fig 2
Fig 2. (A-B): MAC was defined as an echodense area visualized throughout systole and diastole, distinguishable from the posterior mitral valve leaflet, located anterior and parallel to the posterior left ventricular wall, seen here in the apical four chamber view during diastole (A) and systole (B).
Abbreviations: Right Ventricle (RV), Left Ventricle (LV), Mitral Annular Calcification (MAC), Left Atrium (LA), Right Atrium (RA).
Fig 3
Fig 3. M-mode measurement of MAC in the parasternal long axis view.
Abbreviations: Mitral Annular Calcification (MAC).
Fig 4
Fig 4. M-mode measurement of MAC in the apical four chamber view.
MAC—Mitral annular calcification; cm—centimeters. Abbreviations: Mitral Annular Calcification (MAC).
Fig 5
Fig 5. CAC EBCT of a subject with CAC score of 0.
Abbreviations: Coronary artery calcium (CAC), External beam computed tomography (EBCT).
Fig 6
Fig 6. CAC EBCT of a subject with detectable CAC.
Abbreviations: Coronary artery calcium (CAC), External beam computed tomography (EBCT).
Fig 7
Fig 7. HIV-infected individuals with MAC have a higher median age- and gender-adjusted CAC percentile compared to those without MAC.
Abbreviations: Coronary Artery Calcification (CAC), Mitral Annular Calcification (MAC), Interquartile Range (IQR).
Fig 8
Fig 8. Kaplan Meier survival curve for subjects based on presence (+) or absence (-) of Coronary Artery Calcium, Mitral Annular Calcification.
Abbreviations: Coronary Artery Calcification (CAC), Mitral Annular Calcification (MAC).

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