Increased Echocardiographic Pulmonary Pressure in HIV-infected and -uninfected Individuals in the Veterans Aging Cohort Study

被引：27

作者：

Brittain, Evan L. ^{[1
,2
]}

Duncan, Meredith S. ^{[2
]}

Chang, Joyce ^{[3
]}

Patterson, Olga V. ^{[4
,5
]}

DuVall, Scott L. ^{[4
,5
]}

Brandt, Cynthia A. ^{[6
,7
]}

So-Armah, Kaku A. ^{[9
]}

Goetz, Matthew ^{[10
]}

Akgun, Kathleen ^{[8
]}

Crothers, Kristina ^{[11
]}

Zola, Courtney ^{[12
]}

Kim, Joon ^{[13
]}

Gibert, Cynthia ^{[14
,15
]}

Pisani, Margaret ^{[16
]}

Morris, Alison ^{[16
]}

Hsue, Priscilla ^{[17
]}

Tindle, Hilary A. ^{[12
]}

Justice, Amy ^{[8
]}

Freiberg, Matthew ^{[1
,2
,18
]}

机构：

[1] Vanderbilt Univ, Med Ctr, Div Cardiovasc Med, Nashville, TN USA

[2] Vanderbilt Translat & Clin Cardiovasc Res Ctr, Nashville, TN USA

[3] Univ Pittsburgh, Div Gen Internal Med, Pittsburgh, PA USA

[4] Salt Lake City Hlth Care Syst, Dept Vet Affairs, Salt Lake City, UT USA

[5] Univ Utah, Sch Med, Dept Internal Med, Salt Lake City, UT USA

[6] Vet Affairs Connecticut Hlth Care Syst, Div Res, West Haven Vet Adm Med Ctr, West Haven, CT USA

[7] Yale Sch Med, Dept Emergency Med, New Haven, CT USA

[8] Yale Sch Med, Dept Med, New Haven, CT USA

[9] Boston Univ, Div Gen Internal Med, Boston, MA 02215 USA

[10] Vet Affairs Greater Los Angeles Healthcare Syst, Div Infect Dis, Los Angeles, CA USA

[11] Univ Washington, Div Pulm & Crit Care Med, Seattle, WA 98195 USA

[12] Vanderbilt Univ, Sch Med, Dept Med, Nashville, TN 37212 USA

[13] James J Peters Vet Affairs Med Ctr, Div Pulm & Crit Care Med, Bronx, NY USA

[14] George Washington Univ, Dept Med, Sch Med, Washington, DC USA

[15] Washington DC Vet Affairs Med Ctr, Div Infect Dis, Washington, DC USA

[16] Univ Pittsburgh, Med Ctr, Div Pulm Allergy & Crit Care Med, Pittsburgh, PA USA

[17] Univ Calif San Francisco, Div Cardiovasc Med, San Francisco, CA 94143 USA

[18] Vet Hlth Adm, Tennessee Valley Healthcare Syst Geriatr Res Educ, Nashville, TN USA

来源：

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE | 2018年 / 197卷 / 07期

关键词：

human immunodeficiency virus; pulmonary hypertension; patient outcome assessment; electronic health records; echocardiography; ANTIRETROVIRAL THERAPY; ARTERIAL-HYPERTENSION; HEART-FAILURE; DOPPLER-ECHOCARDIOGRAPHY; PROGNOSTIC-FACTORS; HIGH PREVALENCE; RISK-FACTORS; MORTALITY; ASSOCIATION; SURVIVAL;

D O I：

10.1164/rccm.201708-1555OC

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Rationale: The epidemiology and prognostic impact of increased pulmonary pressure among HIV-infected individuals in the antiretroviral therapy era is not well described. Objectives: To examine the prevalence, clinical features, and outcomes of increased echocardiographic pulmonary pressure in HIV-infected and -uninfected individuals. Methods: This study evaluated 8,296 veterans referred for echocardiography with reported pulmonary artery systolic pressure (PASP) estimates from the Veterans Aging Cohort study, an observational cohort of HIV-infected and -uninfected veterans matched by age, sex, race/ethnicity, and clinical site. The primary outcome was adjusted mortality by HIV status. Measurements and Main Results: PASP was reported in 2,831 HIV infected and 5,465 HIV-uninfected veterans (follow-up[mean +/- SD], 3.86 +/- 2.6 yr). As compared with uninfected veterans, HIV-infected veterans with HIV viral load greater than 500 copies/ml (odds ratio, 1.27; 95% confidence interval [CI], 1.05-1.54) and those with CD4 cell count less than 200 cells/mu l (odds ratio, 1.28; 95% CI, 1.02-1.60) had a higher prevalence of PASP greater than or equal to 40 mm Hg. As compared with uninfected veterans with a PASP less than 40 mm Hg, HIV-infected veterans with a PASP greater than or equal to 40 mm Hg had an increased risk of death (adjusted hazard ratio, 1.78; 95% CI, 1.57-2.01). This risk persisted even among participants without prevalent comorbidities (adjusted hazard ratio, 3.61; 95% CI, 2.17-6.01). The adjusted risk of mortality in HIV-infected veterans was higher at all PASP values than in uninfected veterans, including at values currently considered to be normal. Conclusions: HIV-infected people with high HIV viral loads or low CD4 cell counts have a higher prevalence of increased PASP than uninfected people. Mortality risk in HIV-infected veterans increases at lower values of PASP than previously recognized and is present even among those without prevalent comorbidities. These findings may inform clinical decision-making regarding screening and surveillance of pulmonary hypertension in HIV-infected individuals.

引用

页码：923 / 932

页数：10