Department of Radiological Sciences, Cardiovascular and Thoracic Imaging, University of California,Irvine Medical Center, 101 The City Drive South, Orange, California, United States.
Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, South Korea.
Br J Radiol. 2020 May 1;93(1109):20190462. doi: 10.1259/bjr.20190462. Epub 2020 Feb 28.
To evaluate coronary artery calcification (CAC) on routine CT chest in hospitalised HIV patients and to assess individual risk factors.
Routine CT chests, May 2010-November 2015, of 143 hospitalised HIV-positive patients were reviewed for qualitative assessment of calcification in major coronary arteries by two radiologists. Presence, location and burden of calcification were evaluated on 3 mm axial images of CT chest. Cardiovascular risk factors and HIV lab parameters such as CD4 count, viral load and duration, and status of antiretroviral treatment were collected. Statistical analysis including multivariate logistic regression was performed.
Forty-one patients (28.7%) showed CAC, left anterior descending ( = 38, 92.7%), circumflex ( = 18, 43.9%) and Right Coronary Artery ( = 13, 31.7%); mostly mild CAC burden and mostly proximal left coronary arteries with excellent interobserver and intraobserver agreements ( = 0.9, and 1). Age of CAC+ group (53.9 years) was significantly higher than CAC- group (43.4, < 0.001, minimum age of CAC+, 27 years). No significant difference between two groups in sex, ethnicity and risk factors and HAART status. CAC+ group showed significantly longer HIV duration (12.3 years 8.6, < 0.0344) and higher CD4 cell counts (mean = 355.9 175.3, = 0.0053) and significantly lower viral load (76 414K, = 0.02) than CAC- group. On multivariate logistic regression, age, HIV duration and CD4 were significantly associated with CAC+ (-values < .05).
One-third of hospitalised HIV patients showed subclinical CAC on CT chest. HIV duration and age of patients were independent risk factors for developing CAC. Higher CD4 cell count was strongly associated with CAC+.
Routine CT chest with or without contrast performed for non-cardiac indications is helpful in identification of subclinical CAC in HIV patients and radiologists should be encouraged to report CAC.CAC is seen in younger age group in HIV, and awareness of this finding on routine CT chest would help guiding clinicians to assess risk stratification for primary prevention of ischemic heart disease in this population at an earlier stage when compared to normal population.Duration of HIV infection and age of patients were independent risk factors for developing CAC in our study and CD4 count was strongly associated with presence of CAC.
评估住院 HIV 患者常规 CT 胸部的冠状动脉钙化（CAC）情况，并评估个体危险因素。
回顾性分析 2010 年 5 月至 2015 年 11 月期间 143 例住院 HIV 阳性患者的常规 CT 胸部检查，由两名放射科医生对主要冠状动脉的钙化进行定性评估。在 CT 胸部的 3mm 轴位图像上评估钙化的存在、位置和负荷。收集心血管危险因素和 HIV 实验室参数，如 CD4 计数、病毒载量和持续时间，以及抗逆转录病毒治疗的状况。进行包括多变量逻辑回归在内的统计分析。
41 例（28.7%）患者存在 CAC，其中左前降支（ = 38，92.7%）、回旋支（ = 18，43.9%）和右冠状动脉（ = 13，31.7%）；CAC 负荷多为轻度，且多为左冠状动脉近端，观察者间和观察者内的一致性良好（ = 0.9 和 1）。CAC+组（53.9 岁）的年龄明显高于 CAC-组（43.4 岁，<0.001，CAC+的最小年龄为 27 岁）。两组间在性别、种族、危险因素和 HAART 状况方面无显著差异。与 CAC-组相比，CAC+组的 HIV 持续时间明显更长（12.3 年±8.6 年，<0.0344），CD4 细胞计数明显更高（均值=355.9±175.3，=0.0053），病毒载量明显更低（76±414K，=0.02）。多变量逻辑回归分析显示，年龄、HIV 持续时间和 CD4 与 CAC+显著相关（-值<0.05）。
三分之一的住院 HIV 患者在 CT 胸部上显示出亚临床 CAC。HIV 持续时间和患者年龄是 CAC 发生的独立危险因素。较高的 CD4 细胞计数与 CAC+强烈相关。
对于非心脏指征进行的常规 CT 胸部检查有助于识别 HIV 患者的亚临床 CAC，放射科医生应鼓励报告 CAC。在 HIV 中，CAC 出现在更年轻的年龄组，与正常人群相比，在常规 CT 胸部上发现这一发现有助于指导临床医生更早地评估这一人群缺血性心脏病的风险分层，以进行一级预防。在本研究中，HIV 感染持续时间和患者年龄是 CAC 发生的独立危险因素，而 CD4 计数与 CAC 的存在密切相关。
