Madonna Rosalinda, Fabiani Silvia, Morganti Riccardo, Forniti Arianna, Biondi Filippo, Ridolfi Lorenzo, Iapoce Riccardo, Menichetti Francesco, De Caterina Raffaele
Department of Pathology, Cardiology Division, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56124 Pisa, Italy.
Infectious Disease Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56124 Pisa, Italy.
J Clin Med. 2022 Apr 27;11(9):2447. doi: 10.3390/jcm11092447.
Background and Aim: Pulmonary hypertension (PH) at rest can be preceded by the onset of exercise-induced PH (ExPH). We investigated its association with the cardiovascular (CV) risk score in patients with human immunodeficiency virus (HIV). Methods: In 46 consecutive patients with HIV with low (n = 43) or intermediate (n = 3) probability of resting PH, we evaluated the CV risk score based on prognostic determinants of CV risk. Diagnosis of ExPH was made by cardiopulmonary exercise test (CPET) and exercise stress echocardiogram (ESE). Results: Twenty-eight % (n = 13) of the enrolled patients had ExPH at both CPET and ESE, with good agreement between the two methods (Cohen’s kappa = 0.678). ExPH correlated directly with a higher CV score (p < 0.001). Patients with a higher CV score also had lower CD4+ T-cell counts (p = 0.001), a faster progression to acquired immunodeficiency syndrome (p < 0.001), a poor immunological response to antiretroviral therapy (p = 0.035), higher pulmonary vascular resistance (p = 0.003) and a higher right atrial area (p = 0.006). Conclusions: Isolated ExPH is associated with a high CV risk score in patients with HIV. Assessment of ExPH may better stratify CV risk in patients with HIV.
静息性肺动脉高压（PH）可能在运动性肺动脉高压（ExPH）发作之前出现。我们研究了其与人类免疫缺陷病毒（HIV）患者心血管（CV）风险评分的关联。方法：在46例连续的HIV患者中，静息性PH可能性低（n = 43）或中等（n = 3），我们基于CV风险的预后决定因素评估了CV风险评分。通过心肺运动试验（CPET）和运动负荷超声心动图（ESE）诊断ExPH。结果：28%（n = 13）的入选患者在CPET和ESE时均有ExPH，两种方法之间具有良好的一致性（Cohen's kappa = 0.678）。ExPH与较高的CV评分直接相关（p < 0.001）。CV评分较高的患者CD4 + T细胞计数也较低（p = 0.001），进展为获得性免疫缺陷综合征的速度更快（p < 0.001），对抗逆转录病毒治疗免疫反应较差（p = 0.035），肺血管阻力较高（p = 0.003）和右心房面积较大（p = 0.006）。结论：孤立性ExPH与HIV患者的高CV风险评分相关。评估ExPH可能更好地对HIV患者的CV风险进行分层。
