TY - JOUR
T1 - Prevalence and prognostic significance of ECG abnormalities in HIV-infected patients
T2 - Results from the Strategies for Management of Antiretroviral Therapy study
AU - Soliman, Elsayed Z.
AU - Prineas, Ronald J.
AU - Roediger, Mollie P.
AU - Duprez, Daniel A.
AU - Boccara, Franck
AU - Boesecke, Christoph
AU - Stephan, Christoph
AU - Hodder, Sally
AU - Stein, James H.
AU - Lundgren, Jens D.
AU - Neaton, James D.
N1 - Funding Information:
Funding sources: The SMART study was sponsored by the National Institute of Allergy and Infectious Disease, National Institutes of Health (Grants U01AI042170, U01AI46362, and U01AI068641).
PY - 2011/11
Y1 - 2011/11
N2 - Background: It remains debated whether to include resting electrocardiogram (ECG) in the routine care of human immunodeficiency virus (HIV)-infected patients. Methods: This analysis included 4518 HIV-infected patients (28% women and 29% blacks) from the Strategies for Management of Antiretroviral Therapy study, a clinical trial aimed to compare 2 HIV treatment strategies. ECG abnormalities were classified using the Minnesota Code. Cox proportional hazards analysis was used to examine the association between baseline ECG abnormalities and incident cardiovascular disease (CVD). Results: More than half of the participants (n = 2325, or 51.5%) had either minor or major ECG abnormalities. Minor ECG abnormalities (48.6%) were more common than major ECG abnormalities (7.7%). During a median follow-up of 28.7 months, 155 participants (3.4%) developed incident CVD. After adjusting for the study-treatment arms, the presence of major, minor, and either minor or major ECG abnormalities was significantly predictive of incident CVD (hazard ratio [95% confidence interval]: 2.76 [1.74-4.39], P <.001; 1.58 [1.14-2.20], P =.006; 1.57 [1.14-2.18], P =.006, respectively). However, after adjusting for demographics, CVD risk factors, and HIV characteristics (full model), presence of major ECG abnormalities were still significantly predictive of CVD (1.83 [1.12-2.97], P =.015) but not minor or major abnormalities taken together (1.26 [0.89-1.79], P =.18; 1.25 [0.89-1.76], P =.20, respectively). Individual ECG abnormalities that significantly predicted CVD in the fully adjusted model included major isolated ST-T abnormalities, major prolongation of QT interval, minor isolated ST-T, and minor isolated Q-QS abnormalities. Conclusion: Nearly 1 in 2 of the HIV-infected patients in our study had ECG abnormalities; 1 in 13 had major ECG abnormalities. Presence of ECG abnormalities, especially major ECG abnormalities, was independently predictive of incident CVD. These results suggest that the ECG could provide a convenient risk-screening tool in HIV-infected patients.
AB - Background: It remains debated whether to include resting electrocardiogram (ECG) in the routine care of human immunodeficiency virus (HIV)-infected patients. Methods: This analysis included 4518 HIV-infected patients (28% women and 29% blacks) from the Strategies for Management of Antiretroviral Therapy study, a clinical trial aimed to compare 2 HIV treatment strategies. ECG abnormalities were classified using the Minnesota Code. Cox proportional hazards analysis was used to examine the association between baseline ECG abnormalities and incident cardiovascular disease (CVD). Results: More than half of the participants (n = 2325, or 51.5%) had either minor or major ECG abnormalities. Minor ECG abnormalities (48.6%) were more common than major ECG abnormalities (7.7%). During a median follow-up of 28.7 months, 155 participants (3.4%) developed incident CVD. After adjusting for the study-treatment arms, the presence of major, minor, and either minor or major ECG abnormalities was significantly predictive of incident CVD (hazard ratio [95% confidence interval]: 2.76 [1.74-4.39], P <.001; 1.58 [1.14-2.20], P =.006; 1.57 [1.14-2.18], P =.006, respectively). However, after adjusting for demographics, CVD risk factors, and HIV characteristics (full model), presence of major ECG abnormalities were still significantly predictive of CVD (1.83 [1.12-2.97], P =.015) but not minor or major abnormalities taken together (1.26 [0.89-1.79], P =.18; 1.25 [0.89-1.76], P =.20, respectively). Individual ECG abnormalities that significantly predicted CVD in the fully adjusted model included major isolated ST-T abnormalities, major prolongation of QT interval, minor isolated ST-T, and minor isolated Q-QS abnormalities. Conclusion: Nearly 1 in 2 of the HIV-infected patients in our study had ECG abnormalities; 1 in 13 had major ECG abnormalities. Presence of ECG abnormalities, especially major ECG abnormalities, was independently predictive of incident CVD. These results suggest that the ECG could provide a convenient risk-screening tool in HIV-infected patients.
KW - Cardiovascular disease
KW - ECG
KW - HIV/AIDS
KW - SMART study
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U2 - 10.1016/j.jelectrocard.2010.10.027
DO - 10.1016/j.jelectrocard.2010.10.027
M3 - Article
C2 - 21145066
AN - SCOPUS:80054924053
SN - 0022-0736
VL - 44
SP - 779
EP - 785
JO - Journal of Electrocardiology
JF - Journal of Electrocardiology
IS - 6
ER -
