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Assessment of coronary artery disease by CT angiography in HIV positive young adults

Grant number: 13/08976-7
Support type:Regular Research Grants
Duration: April 01, 2014 - September 30, 2016
Field of knowledge:Health Sciences - Medicine - Medical Radiology
Principal Investigator:José Rodrigues Parga Filho
Grantee:José Rodrigues Parga Filho
Home Institution: Instituto do Coração Professor Euryclides de Jesus Zerbini (INCOR). Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil
Assoc. researchers: Luiz Raphael Pereira Donoso Scoppetta ; Marcus Picoral Pinto

Abstract

Since the advent of antiretroviral therapy (ART) in 1996, the mortality associated with acquired immunodeficiency syndrome (AIDS) has been showing a significant reduction. Because HIV patients are living longer, cardiovascular complications have become more frequent and a major cause of morbidity and mortality. Several studies have demonstrated the association of HIV with cardiac abnormalities. Complications may include vascular, myocardial, endocardial and pericardial disease. Among these, coronary artery disease (CAD) and cardiomyopathies are the most important, because of the prevalence and the related morbidity and mortality. Pathophysiological mechanisms of CAD in this group of patients are not fully elucidated, but it is believed that the higher prevalence of traditional cardiovascular risk factors, HIV infection itself and immunological mechanisms are involved and accelerate the process of atherosclerosis. Although the positive therapeutic effect of ART, CAD is also caused by metabolic changes secondary to prolonged treatment, such as lipodystrophy, dyslipidemia and hyperglycemia. The conventional methods for stratifying cardiovascular risk, however, do not take into account risk factors commonly observed in HIV-positive patients. In recent years, major advances in cardiovascular imaging, especially the development of multi-detector CT scans and the development of new pulse sequences of cardiac magnetic resonance (CMR), combined with the highest quality of imaging post-processing, brought the possibility of diagnosing cardiac abnormalities before clinical manifestations occur. The coronary CT angiography (CCTA) is a method that allows evaluating not only the degree of luminal stenosis and the number of coronary segments affected, but also atherosclerotic plaque components and positive remodeling associated. Previous studies have demonstrated that these changes are related to higher incidence of acute coronary syndromes in various clinical settings. Cardiac magnetic resonance imaging is the gold standard for ventricular function evaluation and for myocardial fibrosis characterization and quantification, both recognized as important prognostic factors. Many studies have shown a higher prevalence of ventricular dysfunction in this population, but the pathophysiological mechanisms involved are not fully elucidated. There are indications that interstitial myocardial fibrosis may be implicated in this process. The aim of this study is to evaluate the prevalence of coronary artery disease involvement in HIV-positive asymptomatic young men, and the morphological characteristics of atherosclerotic plaques related. Moreover, as part of a sub study performed simultaneously, ventricular function and the presence of myocardial fibrosis will be evaluated by magnetic resonance. (AU)