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Prevalence and Characterization of Subclinical Coronary
Atherosclerotic Plaque with CT among Individuals with
HIV: Results from the Canadian HIV and Aging Cohort Study
Autores: Irina Boldeanu, BSc • Manel Sadouni, MD • Samer Mansour, MD • Jean-Guy Baril, MD • Benoît Trottier, MD •
Gilles Soulez, MD, MSc • Anne S. Chin, MD • Jonathon Leipsic, MD • Cécile Tremblay, MD •
Madeleine Durand, MD, MSc • Carl Chartrand-Lefebvre, MD, MSc • for the Canadian HIV and Aging Cohort Study Group
Objetivo:
describir los hallazgos de imagen clave en los estudios de RM estructural de las demen- cias de origen neurodegenerativo más frecuentes: enfermedad de Alzheimer, demencia vascular, demencia de cuerpos de Lewy, variantes de la demencia frontotemporal, parálisis supranu- clear progresiva, variantes de la atrofia multisistémica, parkinson-demencia y degeneración corticobasal.
Conclusión:
El papel de la resonancia magnética hoy en día ya no está limitado a excluir causas subyacentes de deterioro cognitivo, sino que puede mostrar patrones de atrofia y otros datos con un alto valor predictivo para determinadas demencias que, aunque no son específicos ni únicos de cada patología, pueden ayudar a confirmar una sospecha diagnóstica o a identificar inicios tempranos de determinados procesos. Por ello es importante que los radiólogos conozcan los hallazgos típicos de las demencias más frecuentes.
Palabras clave: Resonancia magnética; Atrofia; Demencia; Enfermedad de Alzheimer; Parálisis supranuclear progresiva; Demencia vascular; Atrofia multisistémica; Enfermedad de Parkinson; Demencia frontotemporal
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Background:
People living with HIV (PLWH) have a higher risk of myocardial infarction. Coronary atherosclerotic plaque CT characterization helps to predict cardiovascular risk. Purpose:
To measure CT characteristics of coronary plaque in PLWH without known cardiovascular disease and healthy volunteers
without HIV. Materials and Methods:
In this prospective study, noncontrast CT (all participants, n = 265) was used for coronary artery calcium
(CAC) scoring in asymptomatic PLWH and healthy volunteers without HIV, without known cardiovascular disease, from 2012 to
2019. At coronary CT angiography (n = 233), prevalence, frequency, and volume of calcified, mixed, and noncalcified plaque were
measured. Poisson regressions were used with adjustment for cardiovascular risk factors. Results:
There were 181 PLWH (mean age, 56 years 6 7; 167 men) and 84 healthy volunteers (mean age, 57 years 6 8; 65 men)
evaluated by using noncontrast CT. CT angiography was performed in 155 PLWH and 78 healthy volunteers. Median 10-year
Framingham risk score was not different between PLWH and healthy volunteers (10% vs 9%, respectively; P = .45), as were CAC
score (odds ratio [OR], 1.06; 95% CI: 0.58, 1.94; P = .85) and overall plaque prevalence (prevalence ratio, 1.07; 95% CI: 0.86,
1.32; P = .55) after adjustment for cardiovascular risk. Noncalcified plaque prevalence (prevalence ratio, 2.5; 95% CI: 1.07, 5.67;
P = .03) and volume (OR, 2.8; 95% CI: 1.05, 7.40; P = .04) were higher in PLWH. Calcified plaque frequency was reduced in
PLWH (OR, 0.6; 95% CI: 0.40, 0.91; P = .02). Treatment with protease inhibitors was associated with higher volume of overall
(OR, 1.8; 95% CI: 1.09, 2.85; P = .02) and mixed plaque (OR, 1.6; 95% CI: 1.04, 2.45; P = .03). Conclusion:
Noncalcified coronary plaque burden at coronary CT angiography was two- to threefold higher in asymptomatic people
living with HIV without known cardiovascular disease compared with healthy volunteers without HIV.
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