Chandra Divay, Gupta Aman, Leader Joseph K, Fitzpatrick Meghan, Kingsley Lawrence A, Kleerup Eric, Haberlen Sabina A, Budoff Matthew J, Witt Mallory, Post Wendy S, Sciurba Frank C, Morris Alison
Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
PLoS One. 2017 Apr 28;12(4):e0176557. doi: 10.1371/journal.pone.0176557. eCollection 2017.
Individuals with HIV are at increased risk for coronary artery disease (CAD). Early detection of subclinical CAD by assessment of coronary artery calcium (CAC) may help risk stratify and prevent CAD events in these individuals. However, the current standard to quantify CAC i.e. Agatston scoring requires EKG-gated cardiac CT imaging.
To determine if the assessment of CAC using non-EKG-gated chest CT and the Weston scoring system is a useful surrogate for Agatston scores in HIV-infected and HIV-uninfected individuals.
CAC was assessed by both the Weston and Agatston score in 108 men enrolled in the Multicenter AIDS Cohort Study.
Participants were 55.2 (IQR 50.4; 59.9) years old and 62 (57.4%) were seropositive for HIV. Inter-observer agreement (rs = 0.94, κ = 90.0%, p<0.001, n = 21) and intra-observer agreement (rs = 0.95, κ = 95.2%, p<0.001, n = 97) for category of Weston score were excellent. Weston scores were associated with similar CAD risk factors as Agatston scores (age, race, HDL cholesterol level, all p<0.05) in our cohort. There was excellent correlation (rs = 0.92, p<0.001) and agreement (κw = 0.77, p<0.001) between Weston and Agatston scores.
This study is the first to examine calcium scoring using chest CT in HIV-infected individuals and to independently validate the Weston score as a surrogate for the Agatston score. In clinical or research settings where EKG-gated cardiac CT is not feasible for the assessment of coronary calcium, Weston scoring by using chest CT should be considered.
感染HIV的个体患冠状动脉疾病（CAD）的风险增加。通过评估冠状动脉钙化（CAC）来早期检测亚临床CAD可能有助于对这些个体进行风险分层并预防CAD事件。然而，目前量化CAC的标准即阿加斯顿评分需要心电图门控心脏CT成像。
确定使用非心电图门控胸部CT和韦斯顿评分系统评估CAC是否是HIV感染和未感染个体中阿加斯顿评分的有用替代指标。
在多中心艾滋病队列研究中，对108名男性同时采用韦斯顿评分和阿加斯顿评分评估CAC。
参与者年龄为55.2岁（四分位距50.4；59.9），62人（57.4%）HIV血清学呈阳性。韦斯顿评分类别的观察者间一致性（rs = 0.94，κ = 90.0%，p<0.001，n = 21）和观察者内一致性（rs = 0.95，κ = 95.2%，p<0.001，n = 97）极佳。在我们的队列中，韦斯顿评分与阿加斯顿评分具有相似的CAD危险因素（年龄、种族以及高密度脂蛋白胆固醇水平，均p<0.05）。韦斯顿评分与阿加斯顿评分之间存在极佳的相关性（rs = 0.92，p<0.001）和一致性（κw = 0.77，p<0.001）。
本研究首次在HIV感染个体中使用胸部CT检查钙化评分，并独立验证韦斯顿评分可作为阿加斯顿评分的替代指标。在临床或研究环境中，若心电图门控心脏CT无法用于评估冠状动脉钙化，则应考虑使用胸部CT进行韦斯顿评分。
