De Lorenzo Andrea, Meirelles Vanderson, Vilela Felippe, Souza Fernando Cesar C
National Institute of Cardiology, Rio de Janeiro, Brazil.
J Int Assoc Provid AIDS Care. 2013 Mar-Apr;12(2):110-6. doi: 10.1177/1545109712460098. Epub 2012 Sep 26.
Despite the association between HIV and coronary artery disease (CAD), there are no specific recommendations for the cardiovascular evaluation of the HIV-infected population. Besides being a tool for the evaluation of CAD, the exercise treadmill test (ETT) provides insights into functional capacity and autonomic function, which have been frequently affected in HIV infection, and thus may be useful in this setting.
Forty-nine HIV-infected individuals without known CAD underwent ETT. Peak oxygen consumption during exercise (VO2 peak), functional capacity (in metabolic equivalents [METs]), exercise-induced ischemia, chronotropic incompetence (CI) and abnormal heart rate recovery (HRR) after exercise were studied.
VO2 peak was 31.4±4.8 mL/kg/min and functional capacity was 9.2±1.6 MET. CI was observed in 30.6%, and 10.2% had abnormal HRR. VO2 peak was lower in women and inversely correlated with age and body mass index. None of the patients displayed ischemic changes.
Although functional capacity was good, risk markers such as CI and abnormal HRR were not infrequent. This study identifies a subgroup of HIV-infected patients-the older, overweight, or obese-who may have higher risk and deserve cardiovascular screening with the ETT.
尽管人类免疫缺陷病毒（HIV）与冠状动脉疾病（CAD）之间存在关联，但对于HIV感染人群的心血管评估尚无具体建议。运动平板试验（ETT）除了是评估CAD的工具外，还能提供关于功能能力和自主神经功能的见解，而这些在HIV感染中经常受到影响，因此在这种情况下可能有用。
49名无已知CAD的HIV感染个体接受了ETT。研究了运动期间的峰值耗氧量（VO2峰值）、功能能力（以代谢当量[METs]表示）、运动诱发的缺血、变时性功能不全（CI）以及运动后异常的心率恢复（HRR）。
VO2峰值为31.4±4.8 mL/kg/min，功能能力为9.2±1.6 MET。30.6%观察到CI，10.2%有异常的HRR。女性的VO2峰值较低，且与年龄和体重指数呈负相关。没有患者出现缺血性改变。
尽管功能能力良好，但CI和异常HRR等风险标志物并不罕见。本研究确定了一组HIV感染患者——年龄较大者、超重或肥胖者——他们可能具有较高风险，值得通过ETT进行心血管筛查。
