Large lessons learned from small vessels: coronary microvascular dysfunction in HIV.

IF 3.6 3区 医学 Q2 INFECTIOUS DISEASES
Current Opinion in Infectious Diseases Pub Date : 2024-02-01 Epub Date: 2023-10-27 DOI:10.1097/QCO.0000000000000987
Teressa S Thomas, Allie R Walpert, Suman Srinivasa
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引用次数: 0

Abstract

Purpose of review: Large cohort studies have consistently shown the presence of heart failure is approximately doubled among persons with HIV (PWH). Early studies of cardiovascular disease (CVD) in HIV were primarily focused on atherosclerotic burden, and we now have a greater understanding of large vessel disease in HIV. More recent studies have begun to inform us about small vessel disease, or coronary microvascular dysfunction (CMD), in HIV. CMD is recognized to be an important risk factor for adverse events related to heart failure, associated with cardiovascular mortality, and often presents without overt atherosclerotic disease.

Recent findings: In this review, we highlight implications for CMD and relevant clinical studies in HIV. Inflammation and endothelial dysfunction, well known risk factors in HIV, may mediate the pathogenesis of CMD. Initial studies suggest that CMD worsens with ART initiation. Newer studies reveal CMD is present among well treated PWH without known CVD. In addition, myocardial flow reserve (MFR), a marker of CMD, is reduced in HIV similar to diabetes. There also appears to be sex differences, such that CMD is worse among women vs. men with HIV.

Summary: Alterations in the coronary microvasculature may be an important mediator of subclinical myocardial dysfunction that deserves further clinical attention among PWH without known CVD.

从小血管中吸取的大量经验教训:HIV患者的冠状动脉微血管功能障碍。
综述目的:大型队列研究一致表明,艾滋病毒(PWH)感染者心力衰竭的发生率大约翻了一番。早期对HIV心血管疾病(CVD)的研究主要集中在动脉粥样硬化负担上,我们现在对HIV大血管疾病有了更多的了解。最近的研究已经开始让我们了解HIV中的小血管疾病或冠状动脉微血管功能障碍(CMD)。CMD被认为是与心力衰竭相关的不良事件的重要风险因素,与心血管死亡率相关,并且通常没有明显的动脉粥样硬化疾病。最近的发现:在这篇综述中,我们强调了CMD和HIV相关临床研究的意义。炎症和内皮功能障碍是HIV中众所周知的危险因素,可能介导CMD的发病机制。初步研究表明,CMD随着ART的启动而恶化。最新研究表明,在没有已知CVD的良好处理的PWH中存在CMD。此外,心肌血流储备(MFR),CMD的标志物,在HIV中降低,类似于糖尿病。此外,还存在性别差异,因此患有艾滋病毒的女性和男性的CMD更差。总结:冠状动脉微血管的改变可能是亚临床心肌功能障碍的一个重要介质,值得在没有已知CVD的PWH中进一步临床关注。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.70
自引率
2.60%
发文量
121
审稿时长
6-12 weeks
期刊介绍: This reader-friendly, bimonthly resource provides a powerful, broad-based perspective on the most important advances from throughout the world literature. Featuring renowned guest editors and focusing exclusively on two topics, every issue of Current Opinion in Infectious Disease delivers unvarnished, expert assessments of developments from the previous year. Insightful editorials and on-the-mark invited reviews cover key subjects such as HIV infection and AIDS; skin and soft tissue infections; respiratory infections; paediatric and neonatal infections; gastrointestinal infections; tropical and travel-associated diseases; and antimicrobial agents.
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