Schoepf Isabella C, Buechel Ronny R, Kovari Helen, Hammoud Dima A, Tarr Philip E
University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland.
Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.
J Clin Med. 2019 Jul 29;8(8):1125. doi: 10.3390/jcm8081125.
In many, but not all studies, people living with HIV (PLWH) have an increased risk of coronary artery disease (CAD) events compared to the general population. This has generated considerable interest in the early, non-invasive detection of asymptomatic (subclinical) atherosclerosis in PLWH. Ultrasound studies assessing carotid artery intima-media thickness (CIMT) have tended to show a somewhat greater thickness in HIV+ compared to HIV-, likely due to an increased prevalence of cardiovascular (CV) risk factors in PLWH. Coronary artery calcification (CAC) determination by non-contrast computed tomography (CT) seems promising to predict CV events but is limited to the detection of calcified plaque. Coronary CT angiography (CCTA) detects calcified and non-calcified plaque and predicts CAD better than either CAC or CIMT. A normal CCTA predicts survival free of CV events over a very long time-span. Research imaging techniques, including black-blood magnetic resonance imaging of the vessel wall and 18F-fluorodeoxyglucose positron emission tomography for the assessment of arterial inflammation have provided insights into the prevalence of HIV-vasculopathy and associated risk factors, but their clinical applicability remains limited. Therefore, CCTA currently appears as the most promising cardiac imaging modality in PLWH for the evaluation of suspected CAD, particularly in patients <50 years, in whom most atherosclerotic coronary lesions are non-calcified.
在许多（但并非所有）研究中，与普通人群相比，人类免疫缺陷病毒感染者（PLWH）发生冠状动脉疾病（CAD）事件的风险增加。这引发了人们对在PLWH中早期、非侵入性检测无症状（亚临床）动脉粥样硬化的极大兴趣。评估颈动脉内膜中层厚度（CIMT）的超声研究往往显示，与HIV阴性者相比，HIV阳性者的CIMT略厚，这可能是由于PLWH中心血管（CV）危险因素的患病率增加所致。通过非增强计算机断层扫描（CT）测定冠状动脉钙化（CAC）似乎有望预测CV事件，但仅限于检测钙化斑块。冠状动脉CT血管造影（CCTA）可检测钙化和非钙化斑块，并且比CAC或CIMT能更好地预测CAD。正常的CCTA可在很长一段时间内预测无CV事件的生存率。研究成像技术，包括血管壁的黑血磁共振成像和用于评估动脉炎症的18F-氟脱氧葡萄糖正电子发射断层扫描，为了解HIV血管病变的患病率及相关危险因素提供了线索，但其临床适用性仍然有限。因此，目前CCTA似乎是PLWH中评估疑似CAD最有前景的心脏成像方式，特别是在<50岁的患者中，这些患者的大多数动脉粥样硬化性冠状动脉病变是非钙化的。
