School of Medicine (A.S.H.), Johns Hopkins University, Baltimore, MD.
Department of Biostatistics (L.H.E., J.K.U., C.M.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Circulation. 2020 Jan 21;141(3):176-187. doi: 10.1161/CIRCULATIONAHA.119.043042. Epub 2019 Nov 11.
People living with human immunodeficiency virus (HIV+) have greater risk for sudden arrhythmic death than HIV-uninfected (HIV-) individuals. HIV-associated abnormal cardiac repolarization may contribute to this risk. We investigated whether HIV serostatus is associated with ventricular repolarization lability by using the QT variability index (QTVI), defined as a log measure of QT-interval variance indexed to heart rate variance.
We studied 1123 men (589 HIV+ and 534 HIV-) from MACS (Multicenter AIDS Cohort Study), using the ZioXT ambulatory electrocardiography patch. Beat-to-beat analysis of up to 4 full days of electrocardiographic data per participant was performed using an automated algorithm (median analyzed duration [quartile 1-quartile 3]: 78.3 [66.3-83.0] hours/person). QTVI was modeled using linear mixed-effects models adjusted for demographics, cardiac risk factors, and HIV-related and inflammatory biomarkers.
Mean (SD) age was 60.1 (11.9) years among HIV- and 54.2 (11.2) years among HIV+ participants (<0.001), 83% of whom had undetectable (<20 copies/mL) HIV-1 viral load (VL). In comparison with HIV- men, HIV+ men had higher QTVI (adjusted difference of +0.077 [95% CI, +0.032 to +0.123]). The magnitude of this association depended on the degree of viremia, such that in HIV+ men with undetectable VL, adjusted QTVI was +0.064 (95% CI, +0.017 to +0.111) higher than in HIV- men, whereas, in HIV+ men with detectable VL, adjusted QTVI was higher by +0.150 (95% CI, 0.072-0.228) than in HIV- referents. Analysis of QTVI subcomponents showed that HIV+ men had: (1) lower heart rate variability irrespective of VL status, and (2) higher QT variability if they had detectable, but not with undetectable, VL, in comparison with HIV- men. Higher levels of C-reactive protein, interleukin-6, intercellular adhesion molecule-1, soluble tumor necrosis factor receptor 2, and soluble cluster of differentiation-163 (borderline), were associated with higher QTVI and partially attenuated the association with HIV serostatus.
HIV+ men have greater beat-to-beat variability in QT interval (QTVI) than HIV- men, especially in the setting of HIV viremia and heightened inflammation. Among HIV+ men, higher QTVI suggests ventricular repolarization lability, which can increase susceptibility to arrhythmias, whereas lower heart rate variability signals a component of autonomic dysfunction.
与未感染 HIV（HIV-）的个体相比，人类免疫缺陷病毒（HIV+）感染者发生心律失常性猝死的风险更高。HIV 相关的心脏复极异常可能导致这种风险。我们通过 QT 变异性指数（QTVI）来研究 HIV 血清状态是否与心室复极不稳定相关，该指数定义为 QT 间期方差的对数测量值，相对于心率方差的指数。
我们研究了 MACS（多中心 AIDS 队列研究）中的 1123 名男性（589 名 HIV+和 534 名 HIV-），使用 ZioXT 动态心电图贴片。使用自动算法对每位参与者长达 4 天的心电图数据进行逐拍分析（中位数分析时间[四分位数 1-四分位数 3]：78.3 [66.3-83.0] 小时/人）。使用线性混合效应模型对 QTVI 进行建模，模型调整了人口统计学、心脏危险因素以及与 HIV 相关和炎症生物标志物。
与 HIV-男性相比，HIV+男性的平均年龄（标准差）更高（分别为 60.1 [11.9] 岁和 54.2 [11.2] 岁，<0.001），其中 83%的 HIV-1 病毒载量（VL）无法检测到（<20 拷贝/mL）。与 HIV-男性相比，HIV+男性的 QTVI 更高（调整后的差异为+0.077[95%CI：+0.032 至 +0.123]）。这种关联的程度取决于病毒载量的程度，因此在 HIV+男性中，如果 VL 无法检测到，调整后的 QTVI 比 HIV-男性高+0.064（95%CI：+0.017 至 +0.111），而在 HIV+男性中，如果 VL 可检测到，调整后的 QTVI 比 HIV-男性高+0.150（95%CI：0.072 至 0.228）。对 QTVI 亚组分的分析表明，HIV+男性存在以下情况：（1）无论 VL 状态如何，心率变异性均较低，以及（2）如果 VL 可检测到（而非无法检测到），则 QT 变异性较高，与 HIV-男性相比。较高的 C 反应蛋白、白细胞介素-6、细胞间黏附分子-1、可溶性肿瘤坏死因子受体 2 和可溶性 CD163（边缘）水平与 QTVI 较高相关，并且部分减弱了与 HIV 血清状态的关联。
与 HIV-男性相比，HIV+男性的 QT 间期（QTVI）逐拍变异更大，尤其是在 HIV 病毒血症和炎症加重的情况下。在 HIV+男性中，较高的 QTVI 提示心室复极不稳定，这会增加心律失常的易感性，而较低的心率变异性提示自主神经功能障碍的一个组成部分。
