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JACC Heart Fail. 2015 Aug;3(8):591-9. doi: 10.1016/j.jchf.2015.03.007. Epub 2015 Jul 8.

Novel Biomarkers of Cardiac Stress, Cardiovascular Dysfunction, and Outcomes in HIV-Infected Individuals.

Author information

1
Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
2
Department of Medicine, Veteran's Affairs Medical Center, San Francisco, University of California-San Francisco, San Francisco, California.
3
Division of Cardiology, Department of Medicine, San Francisco General Hospital, University of California-San Francisco, San Francisco, California.
4
Laboratory Medicine, San Francisco General Hospital, University of California-San Francisco, San Francisco, California.
5
Division of Cardiology, Department of Medicine, Cedars-Sinai Hospital, Los Angeles, California.
6
San Francisco General Hospital HIV/AIDS Division, Department of Medicine, University of California-San Francisco, San Francisco, California.
7
Department of Epidemiology and Biostatistics, University of California-San Francisco and San Francisco General Hospital HIV/AIDS Division, San Francisco, California.
8
Critical Diagnostics, San Diego, California.
9
Division of Cardiology, Department of Medicine, San Francisco General Hospital, University of California-San Francisco, San Francisco, California. Electronic address: phsue@medsfgh.ucsf.edu.

Abstract

OBJECTIVES:

This study sought to determine whether biomarkers ST2, growth differentiation factor (GDF)-15, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity troponin I are elevated in patients infected with human immunodeficiency virus (HIV) and are associated with cardiovascular dysfunction and all-cause mortality.

BACKGROUND:

HIV-infected patients have high rates of cardiovascular disease. Markers of myocardial stress may identify at-risk patients and provide additional prognostic information.

METHODS:

Biomarkers and echocardiograms were assessed in 332 HIV-infected patients and 50 age- and sex-matched control subjects. Left ventricular systolic dysfunction was defined as ejection fraction <50%, diastolic dysfunction (DD) as stage 1 or higher, and pulmonary hypertension as pulmonary artery systolic pressure ≥35 mm Hg. Mortality data were obtained from the National Death Index.

RESULTS:

Patients with HIV had a median age of 49 years, and 80% were male. Compared with control subjects, HIV-infected patients had higher adjusted percent estimates of all biomarkers except ST2 and interleukin-6. Among HIV-infected patients, 45% had DD; only ST2 was associated with DD (relative risk [RR]: 1.36; p = 0.047). Left ventricular systolic dysfunction was rare in this cohort (5%). Pulmonary hypertension was present in 27% of HIV-infected patients and was associated with GDF-15 (RR: 1.18; p = 0.04), NT-proBNP (RR: 1.18; p = 0.007), and cystatin C (RR: 1.54; p = 0.03). Thirty-eight deaths occurred among HIV-infected patients over a median of 6.1 years. In adjusted analysis, all-cause mortality was independently predicted by ST2 (hazard ratio [HR]: 2.04; p = 0.010), GDF-15 (HR: 1.42; p = 0.0054), high-sensitivity C-reactive protein (HR: 1.25; p = 0.023), and D-dimer (HR: 1.49; p = 0.029). Relationships were unchanged when analyses were restricted to virally suppressed HIV-infected patients receiving antiretroviral therapy.

CONCLUSIONS:

Among HIV-infected patients, ST2 and GDF-15 were associated with both cardiovascular dysfunction and all-cause mortality, and these variables may be useful at identifying those at risk for developing cardiovascular events and death.

KEYWORDS:

HIV; biomarkers; cardiovascular dysfunction; death; mortality

PMID:
26164679
PMCID:
PMC4529774
DOI:
10.1016/j.jchf.2015.03.007
[Indexed for MEDLINE]
Free PMC Article

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