| Part ?:Observation on the characteristics of coronary plaques in HIV-infected patients based on coronary CTABackground and ObjectiveWith the use of highly active antiretroviral therapy(HAART)drugs,the replication of human immunodeficiency virus(HIV)in HIV-infected patients has been effectively inhibited.The mortality of HIV related diseases has been significantly reduced,and cardiovascular disease has become a prominent threat to their death.Coronary computed tomography angiography(CCTA)is the main method to evaluate coronary atherosclerosis with CT.The purpose of this study were to analyze the differences of coronary plaques characteristics between HIV-infected and non-HIV-infected patients and the related risk factors of coronary plaques in HIV-infected patients.Materials and methodsThis study included 152 HIV-infected patients who received coronary calcification score(CACS)and CCTA in the First Affiliated Hospital of Zhengzhou University from March 2017 to March 2019,and 119 non-HIV-infected patients were randomly selected.The 15 segment criteria revised by the American Heart Association(AHA)were used for segment evaluation.To evaluate the characteristics of coronary plaques and the degree of coronary lumen stenosis.There were three types of plaque:calcified plaque,non calcified plaque and mixed plaque.The incidence of any kind of plaque,calcified plaque,non calcified plaque and mixed plaque and the number of involved segments were compared between the two groups.Multivariate Logistic regression analysis was used to analyze the related factors of coronary plaques in HIV-infected patients.ResultsThere was no significant difference between HIV-infected group and non-HIV-infected group in baseline clinical data(P>0.05).There were 66/152(43.4%)and 44/119(37.0%)patients with CACS>0 in HIV-infected group and non-HIV-infected group,respectively.There was no significant difference between the two groups(P>0.05).The proportion of patients with more than 50%coronary lumen stenosis in HIV-infected group and non-HIV-infected group were 44/152(28.9%)and 21/119(17.6%)respectively.There was significant difference between the two groups(P<0.05).When analyzed on a human basis.The proportion of any kind of plaque and non calcified plaque in HIV-infected group and non-HIV-infected group were 107/152(70.4%),92/152(60.5%)and 67/119(56.3%),52/119(43.7%),respectively,and the difference between the two groups was statistically significant(P<0.05).The proportion of calcified plaque and mixed plaque in HIV-infected group and non-HIV-infected group were 61/152(40.1%),42/152,respectively.There was no significant difference between the two groups(P>0.05).When analyzed on a segment basis,the total number of coronary artery segments in HIV-infected group and non-HIV-infected group were 2135 and 1679,respectively.The proportion of segments with any kind of plaque in HIV-infected group and non-HIV-infected group were 417/2135(19.5%)and 284/1679(16.9%),with statistically significant differences between the two groups(P<0.05).The proportion of segments with non calcified plaque in HIV-infected group and non-HIV-infected group were 206/2135(9.6%)and 123/1679(7.3%)respectively,with statistically significant differences between the two groups(P<0.05).The proportion of segments with mixed plaque in HIV-infected group and non-HIV-infected group were 82/2135(3.8%)and 41/1679(2.4%),respectively,and the difference was statistically significant(P<0.05).The proportion of segments with calcified plaque in HIV-infected group and non-HIV-infected group were 208/2135(9.7%)and 194/1679(11.6%),respectively.There was no significant difference between the two groups(P>0.05).Male,age and nadir CD4+T-cell count were related to the formation of coronary plaques in HIV-infected patients[OR(95%CI),P value]were[2.257(1.177,7.541),P=0.035],[1.134(1.032,1.245),P=0.009]and[0.993(0.986,0.999),P=0.018]ConclusionThe incidence of any kind of plaque,non calcified plaque and coronary lumen stenosis more than 50%in HIV-infected patients were higher than that in non-HIV-infected patients,but there were no significant difference in the incidence of calcified plaque and CACS>0,which may be related to the high incidence and mortality of cardiovascular disease in HIV-infected patients.Male,age and the nadir CD4+T-cell count had influence on the formation of atherosclerotic plaques in HIV-infected patients.Part ?:Observation on vulnerable coronary plaques in HIV-infected patients based on coronary CTABackground and ObjectiveThe rupture of vulnerable coronary plaques was closely related to cardiovascular disease,especially acute coronary syndrome(ACS).CCTA has an important value in detecting vulnerable coronary plaques.The high-risk morphological features of coronary plaque identified by CCTA mainly include low attenuation plaque(LAP),positive remodeling(PR),spotty calcium(SC)and napkin-ring sign(NRS).In non-HIV-infected patients,plaques with these high-risk morphological features were easy to develop into "culprit plaque",and can predict plaque rupture prospectively.The purpose of this study was to explore the similarities and differences of vulnerable coronary plaques between HIV-infected and non-HIV-infected patients,and to analyzed the relative risk factors.Materials and methods167 HIV-infected patients and 185 non-HIV-infected patients who underwent coronary CTA at the First Affiliated Hospital of Zhengzhou University from March 2017 to May 2019 were collected.High risk morphological features of coronary plaque mainly include LAP,PR,SC and NRS.The central area of the non calcified plaque with attenuation density less than 30 HU was LAP.The remodeling index(RI)was calculated by the ratio of the diameter of the coronary artery at the site of the plaque to the average diameter of the proximal and distal normal diameters more than 1.1.The focal calcification with maximum diameter less than 3mm in the wall of the coronary artery was SC.The low attenuation density less than 30 HU in the central area of the plaque with marginal density slightly higher but less than 130 HU was NRS.According to the coronary artery disease reporting and data system(CAD-RADS),at least two high-risk morphological features of coronary plaque defined as vulnerable plaque.The type,location and incidence of vulnerable coronary plaques in the two groups were compared and the risk factors were analyzed.ResultsThere was no significant difference in baseline clinical data between HIV-infected group and non-HIV-infected group(P>0.05).The incidence of coronary heart disease in HIV-infected group was higher than that in non-HIV-infected group(P<0.05).There were 2340 coronary artery segments in HIV-infected group,97 of which had vulnerable plaques;2610 segments of non-HIV-infected patients,66 of which had vulnerable plaques.There was a significant difference between the two groups(P<0.05).This study includes 6 vulnerable plaque types:SC+PR,LAP+PR,NRS+PR,SC+NRS,SC+LAP+PR,NRS+SC+PR.LAP+PR.SC+PR and NRS+PR were the most common vulnerable plaque types in HIV-infected group and non-HIV-infected group;6,1 and 3 segments were more likely to occur in HIV-infected group.6,7 and 1 segments were more likely to occur in non-HIV-infected group.The incidence of SC+PR in HIV-infected group was higher than that in non-HIV-infected group(P<0.05).There was no difference in other vulnerable plaques between the two groups(P>0.05).The incidence of vulnerable plaques greater than or equal to 1 coronary segment of HIV-infected group was higher than that in non-HIV-infected group(P<0.05).There was no significant difference in the incidence of vulnerable plaques greater than or equal to 2 or 3 coronary segments of the two groups.Vulnerable coronary plaques in HIV-infected patients were independently correlated with the duration of ART drug[OR=1.29,95%CI(1.04,1.59),P=0.02].ConclusionThe incidence of vulnerable coronary plaques in HIV-infected patients was higher than that in non-HIV-infected patients.ART drug may be an independent risk factor for coronary plaque vulnerability in HIV-infected patients. |
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