Exercise-Induced Pulmonary Hypertension Is Associated with High Cardiovascular Risk in Patients with HIV
Abstract
:1. Introduction
2. Methods
Statistical Analyses
3. Results
4. Discussion
Study Limitations
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Clinical Parameter | ExPH at CPET | Mean | SD | p-Value |
---|---|---|---|---|
Age | no | 54.21 | 9.76 | 0.615 |
yes | 52.38 | 13.86 | ||
BSA | no | 1.91 | 0.20 | 0.475 |
yes | 1.86 | 0.24 | ||
SAP | no | 126.36 | 12.20 | 0.652 |
yes | 124.62 | 10.50 | ||
DAP | no | 74.24 | 7.08 | 0.745 |
yes | 75.00 | 7.07 | ||
ExPH at CPET | ||||
no | yes | |||
Sex | F | 11 | 5 | 0.742 |
M | 22 | 8 | ||
Smoke | no | 16 | 3 | 0.264 |
yes | 16 | 9 | ||
Functional class FC-WHO | I | 32 | 3 | <0.001 |
II | 1 | 0 | ||
III | 0 | 10 | ||
Chronic liver disease | no | 16 | 8 | 0.425 |
yes | 17 | 5 | ||
Kidney disease | no | 29 | 12 | 0.664 |
yes | 4 | 1 | ||
Thyroid disease | no | 29 | 11 | 0.767 |
yes | 4 | 2 | ||
Arterial hypertension | no | 29 | 13 | 0.189 |
yes | 4 | 0 | ||
Dyslipidemia | no | 10 | 6 | 0.309 |
yes | 23 | 7 | ||
Diabetes mellitus | no | 29 | 11 | 0.767 |
yes | 4 | 2 | ||
Familiarity for CAD | no | 26 | 10 | 0.891 |
yes | 7 | 3 | ||
Calcium channel blockers | no | 29 | 12 | 0.206 |
yes | 4 | 0 | ||
Hypoglycemic drugs | no | 10 | 6 | 0.309 |
yes | 23 | 7 | ||
Beta blockers | no | 32 | 13 | 0.526 |
yes | 1 | 0 | ||
ACE inhibitors or sartanics | no | 32 | 13 | 0.526 |
yes | 1 | 0 | ||
Thyroid hormones | no | 29 | 11 | 0.767 |
yes | 4 | 2 | ||
Lipid lowering drugs | no | 10 | 6 | 0.309 |
yes | 23 | 7 |
Factor | ExPH at ESE | Mean | SD | p-Value |
---|---|---|---|---|
Age | no | 54.58 | 9.94 | 0.391 |
yes | 51.46 | 13.33 | ||
BSA | no | 1.90 | 0.20 | 0.932 |
yes | 1.89 | 0.25 | ||
Heart rate | no | 69.03 | 6.30 | 0.839 |
yes | 68.62 | 5.98 | ||
yes | 126.92 | 9.47 | ||
DAP | no | 73.79 | 7.18 | 0.308 |
yes | 76.15 | 6.50 | ||
ExPH at ESE | ||||
Factor | no | yes | p-value | |
Sex | F | 12 | 4 | 0.720 |
M | 21 | 9 | ||
Smoke | no | 15 | 4 | 0.570 |
ex | 1 | 1 | ||
yes | 17 | 8 | ||
Functional class FC-WHO | I | 31 | 4 | <0.001 |
II | 1 | 0 | ||
III | 1 | 9 | ||
Chronic liver disease | no | 15 | 9 | 0.146 |
yes | 18 | 4 | ||
Kidney disease | no | 29 | 12 | 0.664 |
yes | 4 | 1 | ||
Thyroid disease | no | 28 | 12 | 0.499 |
yes | 5 | 1 | ||
Arterial hypertension | no | 30 | 12 | 0.880 |
yes | 3 | 1 | ||
Dyslipidemia | no | 9 | 7 | 0.088 |
yes | 24 | 6 | ||
Diabetes mellitus | no | 28 | 12 | 0.499 |
yes | 5 | 1 | ||
Familiarity for CAD | no | 27 | 9 | 0.351 |
yes | 6 | 4 | ||
Calcium channel blockers | no | 30 | 11 | 0.937 |
yes | 3 | 1 | ||
Hypoglycemic drugs | no | 9 | 7 | 0.088 |
yes | 24 | 6 | ||
Beta blockers | no | 33 | 12 | 0.107 |
yes | 0 | 1 | ||
ACE inhibitors or sartanics | no | 32 | 13 | 0.526 |
yes | 1 | 0 | ||
Thyroid hormones | no | 28 | 12 | 0.499 |
yes | 5 | 1 | ||
Lipid lowering drugs | no | 9 | 7 | 0.088 |
yes | 24 | 6 |
Continuous Ultrasound Parameters | ExPH at CPET | Mean | SD | p-Value |
---|---|---|---|---|
LVEDD | no | 43.656 | 5.522 | 0.959 |
yes | 43.558 | 5.978 | ||
LVESD | no | 26.656 | 6.439 | 0.442 |
yes | 24.917 | 7.090 | ||
LVEDV | no | 103.875 | 31.270 | 0.299 |
yes | 93.000 | 28.451 | ||
iLVEDV | no | 36.676 | 10.597 | 0.163 |
yes | 31.559 | 10.808 | ||
LVESV | no | 38.219 | 14.041 | 0.314 |
yes | 33.167 | 16.219 | ||
iLVESV | no | 13.416 | 4.944 | 0.384 |
yes | 11.923 | 5.184 | ||
LV | no | 152.884 | 48.281 | 0.443 |
yes | 140.817 | 38.913 | ||
iLVmass | no | 79.132 | 29.520 | 0.255 |
yes | 68.110 | 24.111 | ||
LAD | no | 48.359 | 8.571 | 0.919 |
yes | 48.083 | 5.744 | ||
LAV | no | 38.778 | 20.368 | 0.294 |
yes | 32.317 | 7.786 | ||
iLAV | no | 13.683 | 7.657 | 0.468 |
yes | 12.000 | 3.149 | ||
LVEF | no | 65.147 | 6.406 | 0.584 |
yes | 66.500 | 9.200 | ||
FwSV | no | 72.366 | 22.197 | 0.268 |
yes | 63.750 | 24.000 | ||
iFwSV | no | 25.367 | 7.810 | 0.195 |
yes | 21.745 | 8.944 | ||
MR | no | 0.688 | 0.780 | 0.027 |
yes | 0.250 | 0.452 | ||
AO | no | 0.250 | 0.672 | 1.000 |
yes | 0.250 | 0.622 | ||
E wave | no | 69.769 | 17.989 | 0.993 |
yes | 69.817 | 14.658 | ||
A wave | no | 71.397 | 30.384 | 0.783 |
yes | 74.167 | 26.889 | ||
Septal e wave | no | 9.959 | 3.003 | 0.837 |
yes | 9.767 | 1.837 | ||
E/A | no | 1.067 | 0.394 | 0.909 |
yes | 1.085 | 0.629 | ||
E/e | no | 6.458 | 3.408 | 0.299 |
yes | 7.575 | 2.193 | ||
iRVESA | no | 4.055 | 1.879 | 0.396 |
yes | 4.578 | 1.542 | ||
iRVEDA | no | 6.955 | 2.143 | 0.991 |
yes | 6.947 | 2.343 | ||
iRVESV | no | 7.161 | 4.907 | 0.908 |
yes | 7.338 | 2.902 | ||
iRVEDV | no | 16.048 | 6.550 | 0.220 |
yes | 13.507 | 4.273 | ||
RD1 | no | 36.128 | 7.270 | 0.822 |
yes | 36.667 | 6.372 | ||
RD2 | no | 33.472 | 5.483 | 0.116 |
yes | 30.333 | 6.513 | ||
RD3 | no | 20.503 | 6.485 | 0.041 |
yes | 16.083 | 5.351 | ||
RVOT prox. | no | 31.716 | 6.057 | 0.627 |
yes | 30.792 | 3.905 | ||
RVOT dist. | no | 32.353 | 7.471 | 0.166 |
yes | 29.042 | 5.163 | ||
eccentricity index | no | 0.941 | 0.110 | 0.475 |
yes | 0.914 | 0.103 | ||
RV/LV basal diameter ratio | no | 0.864 | 0.162 | 0.317 |
yes | 0.808 | 0.162 | ||
TAPSE | no | 21.913 | 7.104 | 0.707 |
yes | 22.842 | 7.665 | ||
FAC | no | 45.053 | 9.607 | 0.210 |
yes | 49.083 | 8.554 | ||
RV E/A | no | 4.338 | 13.318 | 0.389 |
yes | 0.963 | 0.408 | ||
RV E/e | no | 3.673 | 1.829 | 0.683 |
yes | 3.938 | 1.891 | ||
RV S vel | no | 10.993 | 4.485 | 0.630 |
yes | 11.767 | 5.301 | ||
RV S VTI | no | 3.608 | 4.050 | 0.024 |
yes | 1.810 | 0.926 | ||
TR | no | 1.219 | 0.491 | 0.862 |
yes | 1.250 | 0.622 | ||
sPAP | no | 22.375 | 5.752 | 0.749 |
yes | 21.750 | 5.675 | ||
sPAP at exercise peak | no | 32.847 | 10.602 | 0.028 |
yes | 40.767 | 9.452 | ||
mPAP | no | 16.333 | 3.623 | 0.969 |
yes | 16.385 | 4.636 | ||
TRV | no | 2.009 | 0.373 | 0.622 |
yes | 2.075 | 0.449 | ||
TRV at exercise peak | no | 2.544 | 0.555 | 0.557 |
yes | 2.658 | 0.616 | ||
RV outflow AT | no | 102.714 | 42.717 | 0.014 |
yes | 138.167 | 34.821 | ||
VCI diameter | no | 15.016 | 3.777 | 0.571 |
yes | 14.158 | 5.896 | ||
RA area | no | 14.709 | 3.227 | 0.295 |
yes | 15.875 | 3.294 | ||
iRAV | no | 5.356 | 2.191 | 0.410 |
yes | 5.924 | 1.420 | ||
VTI at rvot | no | 15.843 | 3.811 | <0.001 |
yes | 11.167 | 2.916 | ||
VRT/VTI at rvot | no | 0.156 | 0.142 | 0.414 |
yes | 0.191 | 0.051 | ||
TAPSE/PAPs | no | 1.033 | 0.347 | 0.609 |
yes | 1.100 | 0.471 | ||
Categorical ultrasound parameters | ExPH at ESE | no | yes | p-value |
Concentric remodeling | no | 19 | 5 | 0.293 |
yes | 13 | 7 | ||
Normal geometry | no | 18 | 7 | 0.901 |
yes | 14 | 5 | ||
Concentric hypertrophy | no | 29 | 12 | 0.272 |
yes | 3 | 0 | ||
Eccentric hypertrophy | no | 31 | 12 | 0.536 |
yes | 1 | 0 |
Continuous Ultrasound Parameters | ExPH at ESE | Mean | SD | p-Value |
---|---|---|---|---|
LVEDD | no | 43.459 | 5.322 | 0.745 |
yes | 44.083 | 6.445 | ||
LVESD | no | 26.625 | 6.460 | 0.472 |
yes | 25.000 | 7.058 | ||
LVEDV | no | 100.938 | 31.460 | 0.992 |
yes | 100.833 | 29.489 | ||
iLVEDV | no | 35.857 | 10.955 | 0.568 |
yes | 33.743 | 10.596 | ||
LVESV | no | 36.406 | 14.555 | 0.752 |
yes | 38.000 | 15.486 | ||
iLVESV | no | 12.992 | 5.205 | 0.971 |
yes | 13.054 | 4.604 | ||
LV | no | 149.453 | 44.358 | 0.974 |
yes | 149.967 | 51.515 | ||
iLV mass | no | 77.544 | 28.061 | 0.593 |
yes | 72.343 | 29.882 | ||
LAD | no | 48.531 | 8.481 | 0.737 |
yes | 47.625 | 6.057 | ||
LAV | no | 38.844 | 19.955 | 0.276 |
yes | 32.142 | 10.252 | ||
iLAV | no | 13.895 | 7.507 | 0.290 |
yes | 11.452 | 3.692 | ||
LVEF | no | 66.459 | 7.437 | 0.157 |
yes | 63.000 | 6.030 | ||
FwSV | no | 73.022 | 24.849 | 0.155 |
yes | 62.000 | 13.671 | ||
iFwSV | no | 25.663 | 8.952 | 0.090 |
yes | 20.957 | 4.347 | ||
MR | no | 0.656 | 0.787 | 0.193 |
yes | 0.333 | 0.492 | ||
AO | no | 0.313 | 0.738 | 0.304 |
yes | 0.083 | 0.289 | ||
E wave | no | 68.084 | 18.606 | 0.284 |
yes | 74.308 | 10.979 | ||
A wave | no | 71.400 | 30.367 | 0.784 |
yes | 74.158 | 26.943 | ||
Septal e wave | no | 10.128 | 2.958 | 0.384 |
yes | 9.317 | 1.908 | ||
E/A | no | 1.037 | 0.397 | 0.415 |
yes | 1.166 | 0.613 | ||
E/e | no | 6.251 | 3.400 | 0.077 |
yes | 8.129 | 1.778 | ||
iRVESA | no | 4.083 | 1.862 | 0.492 |
yes | 4.505 | 1.622 | ||
iRVEDA | no | 7.029 | 2.113 | 0.708 |
yes | 6.749 | 2.405 | ||
iRVESV | no | 7.183 | 4.886 | 0.950 |
yes | 7.278 | 3.001 | ||
iRVEDV | no | 16.217 | 6.461 | 0.126 |
yes | 13.058 | 4.326 | ||
RD1 | no | 35.987 | 6.920 | 0.660 |
yes | 37.042 | 7.344 | ||
RD2 | no | 33.188 | 5.538 | 0.297 |
yes | 31.092 | 6.712 | ||
RD3 | no | 20.031 | 6.699 | 0.222 |
yes | 17.342 | 5.520 | ||
RVOT prox. | no | 31.119 | 5.782 | 0.505 |
yes | 32.383 | 4.882 | ||
RVOT dist. | no | 31.656 | 7.305 | 0.754 |
yes | 30.900 | 6.468 | ||
Eccentricity index | no | 0.943 | 0.112 | 0.335 |
yes | 0.908 | 0.096 | ||
RV/LV basal diameter ratio | no | 0.852 | 0.157 | 0.815 |
yes | 0.839 | 0.179 | ||
TAPSE | no | 21.707 | 6.949 | 0.495 |
yes | 23.392 | 7.958 | ||
FAC | no | 45.397 | 9.376 | 0.391 |
yes | 48.167 | 9.609 | ||
RV E/A | no | 4.333 | 13.319 | 0.391 |
yes | 0.976 | 0.431 | ||
RV E/e | no | 3.729 | 1.882 | 0.946 |
yes | 3.774 | 1.739 | ||
RV S vel | no | 10.950 | 4.497 | 0.561 |
yes | 11.883 | 5.251 | ||
RV S VTI | no | 3.174 | 3.328 | 0.867 |
yes | 2.968 | 4.289 | ||
TR | no | 1.313 | 0.471 | 0.077 |
yes | 1.000 | 0.603 | ||
sPAP | no | 22.344 | 6.003 | 0.794 |
yes | 21.833 | 4.896 | ||
sPAP at exercise peak | no | 30.909 | 8.846 | <0.001 |
yes | 45.933 | 7.504 | ||
mPAP | no | 16.351 | 3.802 | 0.991 |
yes | 16.337 | 4.212 | ||
TRV | no | 2.009 | 0.389 | 0.622 |
yes | 2.075 | 0.409 | ||
TRV at exercise peak | no | 2.472 | 0.502 | 0.048 |
yes | 2.850 | 0.659 | ||
RV outflow AT | no | 105.027 | 43.990 | 0.065 |
yes | 132.000 | 36.352 | ||
VCI diameter | no | 14.722 | 4.534 | 0.885 |
yes | 14.942 | 4.191 | ||
RA area | no | 14.253 | 3.127 | 0.008 |
yes | 17.092 | 2.710 | ||
iRAV | no | 5.266 | 2.186 | 0.189 |
yes | 6.166 | 1.300 | ||
VTI at rvot | no | 16.065 | 3.552 | <0.001 |
yes | 10.575 | 2.703 | ||
VRT/VTI at rvot | no | 0.153 | 0.143 | 0.289 |
yes | 0.198 | 0.041 | ||
TAPSE/PAPs | no | 1.024 | 0.321 | 0.448 |
yes | 1.123 | 0.516 | ||
Categorical ultrasound parameter | ExPH at ESE | no | yes | p-value |
Concentric remodeling | no | 19 | 5 | 0.293 |
yes | 13 | 7 | ||
Normal geometry | no | 18 | 7 | 0.901 |
yes | 14 | 5 | ||
Concentric hypertrophy | no | 29 | 12 | 0.272 |
yes | 3 | 0 | ||
Eccentric hypertrophy | no | 31 | 12 | 0.536 |
yes | 1 | 0 |
References
- Galie, N.; Humbert, M.; Vachiery, J.L.; Gibbs, S.; Lang, I.; Torbicki, A.; Simonneau, G.; Peacock, A.; Vonk Noordegraaf, A.; Beghetti, M.; et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur. Heart J. 2016, 37, 67–119. [Google Scholar] [PubMed]
- Nunes, H.; Humbert, M.; Sitbon, O.; Morse, J.H.; Deng, Z.; Knowles, J.A.; Le Gall, C.; Parent, F.; Garcia, G.; Hervé, P.; et al. Prognostic factors for survival in human immunodeficiency virus-associated pulmonary arterial hypertension. Am. J. Respir. Crit. Care Med. 2003, 167, 1433–1439. [Google Scholar] [CrossRef] [PubMed]
- Tolle, J.J.; Waxman, A.B.; Van Horn, T.L.; Pappagianopoulos, P.P.; Systrom, D.M. Exercise-induced pulmonary arterial hypertension. Circulation 2008, 118, 2183–2189. [Google Scholar] [CrossRef] [PubMed]
- Doukky, R.; Lee, W.Y.; Ravilla, M.; Lateef, O.B.; Pelaez, V.; French, A.; Tandon, R. A novel expression of exercise induced pulmonary hypertension in human immunodeficiency virus patients: A pilot study. Open Cardiovasc. Med. J. 2012, 6, 44–49. [Google Scholar] [CrossRef]
- Alkotob, M.L.; Soltani, P.; Sheatt, M.A.; Katsetos, M.C.; Rothfield, N.; Hager, W.D.; Foley, R.J.; Silverman, D.I. Reduced exercise capacity and stress-induced pulmonary hypertension in patients with scleroderma. Chest 2006, 130, 176–181. [Google Scholar] [CrossRef]
- Saggar, R.; Sitbon, O. Hemodynamics in pulmonary arterial hypertension: Current and future perspectives. Am. J. Cardio. 2012, 110, S9–S15. [Google Scholar] [CrossRef]
- Lewis, G.D.; Bossone, E.; Naeije, R.; Grünig, E.; Saggar, R.; Lancellotti, P.; Ghio, S.; Varga, J.; Rajagopalan, S.; Oudiz, R.; et al. Pulmonary vascular hemodynamic response to exercise in cardiopulmonary diseases. Circulation 2013, 128, 1470–1479. [Google Scholar] [CrossRef]
- McLaughlin, V.V.; Archer, S.L.; Badesch, D.B.; Barst, R.J.; Farber, H.W.; Lindner, J.R.; Mathier, M.A.; McGoon, M.D.; Park, M.H.; Rosenson, R.S.; et al. ACCF/AHA 2009 expert consensus document on pulmonary hypertension: A report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: Developed in collaboration with the American College of Chest Physicians, American Thoracic Society, Inc., and the Pulmonary Hypertension Association. Circulation 2009, 119, 2250–2294. [Google Scholar]
- Madonna, R.; Bonitatibus, G.; Vitulli, P.; Pierdomenico, S.D.; Galie, N.; De Caterina, R. Association of the European Society of Cardiology echocardiographic probability grading for pulmonary hypertension with short and mid-term clinical outcomes after heart valve surgery. Vasc. Pharm. 2020, 125–126, 106648. [Google Scholar] [CrossRef]
- Borlaug, B.A.; Nishimura, R.A.; Sorajja, P.; Lam, C.S.; Redfield, M.M. Exercise hemodynamics enhance diagnosis of early heart failure with preserved ejection fraction. Circ. Heart Fail. 2010, 3, 588–595. [Google Scholar] [CrossRef]
- Madonna, R.; Morganti, R.; Radico, F.; Vitulli, P.; Mascellanti, M.; Amerio, P.; De Caterina, R. Isolated Exercise-Induced Pulmonary Hypertension Associates with Higher Cardiovascular Risk in Scleroderma Patients. J. Clin. Med. 2020, 9, 1910. [Google Scholar] [CrossRef] [PubMed]
- Madonna, R.; Fabiani, S.; Morganti, R.; Forniti, A.; Mazzola, M.; Menichetti, F.; De Caterina, R. Exercise-induced pulmonary hypertension in HIV patients: Association with poor clinical and immunological status. Vasc. Pharmacol. 2021, 139, 106888. [Google Scholar] [CrossRef] [PubMed]
- Sicari, R.; Nihoyannopoulos, P.; Evangelista, A.; Kasprzak, J.; Lancellotti, P.; Poldermans, D.; Voigt, J.U.; Zamorano, J.L. Stress echocardiography expert consensus statement: European Association of Echocardiography (EAE) (a registered branch of the ESC). Eur. J. Echocardiogr. 2008, 9, 415–437. [Google Scholar] [CrossRef] [PubMed]
- Nagel, C.; Henn, P.; Ehlken, N.; D’Andrea, A.; Blank, N.; Bossone, E.; Böttger, A.; Fiehn, C.; Fischer, C.; Lorenz, H.M.; et al. Stress Doppler echocardiography for early detection of systemic sclerosis-associated pulmonary arterial hypertension. Arthritis Res. Ther. 2015, 17, 165. [Google Scholar] [CrossRef]
- Argiento, P.; Chesler, N.; Mule, M.; D’Alto, M.; Bossone, E.; Unger, P.; Naeije, R. Exercise stress echocardiography for the study of the pulmonary circulation. Eur. Respir. J. 2010, 35, 1273–1278. [Google Scholar] [CrossRef]
- Rudski, L.G.; Lai, W.W.; Afilalo, J.; Hua, L.; Handschumacher, M.D.; Chandrasekaran, K.; Solomon, S.D.; Louie, E.K.; Schiller, N.B. Guidelines for the echocardiographic assessment of the right heart in adults: A report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J. Am. Soc. Echocardiogr. 2010, 23, 685–713, quiz 786–688. [Google Scholar]
- Baumgartner, H.; Hung, J.; Bermejo, J.; Chambers, J.B.; Evangelista, A.; Griffin, B.P.; Iung, B.; Otto, C.M.; Pellikka, P.A.; Quiñones, M. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J. Am. Soc. Echocardiogr. 2009, 22, 1–23, quiz 101–102. [Google Scholar] [CrossRef]
- Cagnina, A.; Michaux, S.; Ancion, A.; Cardos, B.; Damas, F.; Lancellotti, P. European guidelines for the diagnosis and management of acute pulmonary embolism. Rev. Med. Liege 2021, 76, 208–215. [Google Scholar]
- Belardine, R., III. Il Test da Sforzo Cardiopolmonare; Midia: Monza, Italy, 2006. [Google Scholar]
- Wassermann, K. Cardiopulmonary Exercise Testing and Cardiovascular Health; Wiley-Blackwell: Hoboken, NJ, USA, 2002. [Google Scholar]
- Badesch, D.B.; Champion, H.C.; Gomez Sanchez, M.A.; Hoeper, M.M.; Loyd, J.E.; Manes, A.; McGoon, M.; Naeije, R.; Olschewski, H.; Oudiz, R.J.; et al. Diagnosis and assessment of pulmonary arterial hypertension. J. Am. Coll. Cardiol. 2009, 54, S55–S66. [Google Scholar] [CrossRef]
- Sciume, M.; Mattiello, V.; Cattaneo, D.; Bucelli, C.; Orofino, N.; Gandolfi, L.; Pettine, L.; Lonati, S.; Gianelli, U.; Pierini, A.; et al. Early detection of pulmonary hypertension in primary myelofibrosis: The role of echocardiography, cardiopulmonary exercise testing, and biomarkers. Am. J. Hematol. 2017, 92, E47–E48. [Google Scholar] [CrossRef]
- Guazzi, M. Pulmonary hypertension in heart failure preserved ejection fraction: Prevalence, pathophysiology, and clinical perspectives. Circ. Heart Fail. 2014, 7, 367–377. [Google Scholar] [CrossRef] [PubMed]
- Kessler, K.M.; Willens, H.J.; Mallon, S.M. Diastolic left ventricular dysfunction leading to severe reversible pulmonary hypertension. Am. Heart J. 1993, 126, 234–235. [Google Scholar] [CrossRef]
- Quezada, M.; Martin-Carbonero, L.; Soriano, V.; Vispo, E.; Valencia, E.; Moreno, V.; de Isla, L.P.; Lennie, V.; Almería, C.; Zamorano, J.L. Prevalence and risk factors associated with pulmonary hypertension in HIV-infected patients on regular follow-up. Aids 2012, 26, 1387–1392. [Google Scholar] [CrossRef]
- Degano, B.; Guillaume, M.; Savale, L.; Montani, D.; Jaïs, X.; Yaici, A.; Le Pavec, J.; Humbert, M.; Simonneau, G.; Sitbon, O. HIV-associated pulmonary arterial hypertension: Survival and prognostic factors in the modern therapeutic era. Aids 2010, 24, 67–75. [Google Scholar] [CrossRef] [PubMed]
- Feinstein, M.J.; Hsue, P.Y.; Benjamin, L.A.; Bloomfield, G.S.; Currier, J.S.; Freiberg, M.S.; Grinspoon, S.K.; Levin, J.; Longenecker, C.T.; Post, W.S.; et al. Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV: A Scientific Statement From the American Heart Association. Circulation 2019, 140, e98–e124. [Google Scholar] [CrossRef]
- Pellicelli, A.M.; Palmieri, F.; D’Ambrosio, C.; Rianda, A.; Boumis, E.; Girardi, E.; Antonucci, G.; D’Amato, C.; Borgia, M.C. Role of human immunodeficiency virus in primary pulmonary hypertension—Case reports. Angiology 1998, 49, 1005–1011. [Google Scholar] [CrossRef]
- Parikh, R.V.; Scherzer, R.; Nitta, E.M.; Leone, A.; Hur, S.; Mistry, V.; Macgregor, J.S.; Martin, J.N.; Deeks, S.G.; Ganz, P.; et al. Increased levels of asymmetric dimethylarginine are associated with pulmonary arterial hypertension in HIV infection. Aids 2014, 28, 511–519. [Google Scholar] [CrossRef]
- Tcherakian, C.; Couderc, L.J.; Humbert, M.; Godot, V.; Sitbon, O.; Devillier, P. Inflammatory mechanisms in HIV-associated pulmonary arterial hypertension. Semin. Respir. Crit. Care Med. 2013, 34, 645–653. [Google Scholar]
CV Score | p-Value | |
---|---|---|
ExPH at CPET | <0.001 | |
no | 8.8 (0.7) | |
yes | 12.9 (2.1) | |
ExPH at ESE | <0.001 | |
no | 8.9 (1.1) | |
yes | 12.5 (2.4) |
Statistics | p-Value | |
---|---|---|
Time to HIV diagnosis (y) | −0.155 | 0.309 |
CD4+ T-cell count at diagnosis (cell/mmc) | −0.402 | 0.012 |
CD4+ T-cell count at diagnosis (%) | −0.380 | 0.020 |
CD4+ T-cell count last determination (cell/mmc) | −0.386 | 0.009 |
CD4+ T-cell count last determination (%) | −0.480 | 0.001 |
Clinical progression to AIDS | <0.001 | |
no | 8.8 (1.1) | |
yes | 12.9 (2) | |
Development of resistance to ART | 0.451 | |
no | 9.8 (2.1) | |
yes | 10.4 (2.7) | |
HIV-RNA levels at diagnosis (cp/mL) | −0.116 | 0.502 |
HIV-RNA levels last determination (cp/mL) | 0.010 | 0.949 |
HIV-RNA levels last determination (cp/mL) | 0.949 | |
<20 cp/mL | 9.9 (2.3) | |
>20 cp/mL | 10 (2.3) | |
Time to beginning of ART | −0.182 | 0.226 |
Current use of protease inhibitors | 0.101 | |
no | 9.8 (2.2) | |
yes | 11.5 (2.7) | |
Combination of ART with booster (ritonavir or cobicistat) | 0.827 | |
no | 10.1 (2.4) | |
yes | 9.9 (2.4) | |
Virologic response to ART | 0.690 | |
<20 copies/mL | 9.7 (2.2) | |
20–50 copies/mL | 10.1 (2.3) | |
50–200 copies/mL | 11.5 (3.5) | |
>200 copies/mL | 10.7 (2.9) | |
Immunologic response to ART | 0.035 * | |
optimal | 9.3 (1.8) | |
acceptable | 10.6 (2.6) | |
not acceptable | 12.3 (2.9) | |
ART discontinuation | 0.536 | |
no | 10.2 (2.4) | |
yes | 9.7 (2.3) | |
IL-6 | 0.289 | 0.152 |
PCR | −0.247 | 0.224 |
VES | 0.194 | 0.354 |
FBG | −0.053 | 0.789 |
Parameter | Statistics | p-Value |
---|---|---|
Concentric remodeling | 0.557 | |
no | 9.9 (2.2) | |
yes | 10.3 (2.6) | |
Normal geometry | 0.755 | |
no | 10.1 (2.4) | |
yes | 9.9 (2.3) | |
Concentric hypertrophy | 0.014 | |
no | 10.2 (2.4) | |
yes | 8.7 (0.6) | |
Eccentric hypertrophy | 0.383 | |
no | 10 (2.3) | |
yes | 11.5 (3.5) | |
LAD | −0.055 | 0.718 |
LAV | −0.076 | 0.620 |
iLAV | −0.067 | 0.667 |
LVEF | −0.164 | 0.281 |
FwSV | −0.097 | 0.527 |
iFwSV | −0.112 | 0.465 |
MR | −0.102 | 0.503 |
AO | −0.146 | 0.339 |
MS | −0.069 | 0.651 |
AS | −0.069 | 0.651 |
E wave | 0.116 | 0.448 |
A wave | 0.153 | 0.315 |
Septal e wave | 0.025 | 0.871 |
E/A | −0.107 | 0.485 |
E/e | 0.178 | 0.242 |
iRVESA | 0.133 | 0.385 |
iRVEDA | 0.069 | 0.652 |
iRVESV | 0.124 | 0.419 |
iRVEDV | −0.133 | 0.385 |
RD1 | 0.075 | 0.626 |
RD2 | −0.215 | 0.157 |
RD3 | −0.275 | 0.068 |
RVOT prox. | −0.081 | 0.596 |
RVOT dist. | 0.071 | 0.644 |
Eccentricity index | −0.207 | 0.171 |
RV/LV basal diameter ratio | −0.192 | 0.205 |
TAPSE | 0.088 | 0.564 |
FAC | 0.179 | 0.240 |
RV E/A | −0.140 | 0.358 |
RV E/e | −0.026 | 0.869 |
RV S vel | 0.151 | 0.322 |
RV S VTI | −0.245 | 0.104 |
TR | −0.127 | 0.407 |
sPAP | −0.018 | 0.906 |
aPAP at exercise peak | 0.269 | 0.074 |
mPAP | 0.036 | 0.814 |
TRV | 0.115 | 0.454 |
TRV at exercise peak | 0.032 | 0.834 |
RV outflow AT | 0.207 | 0.173 |
VCI diameter | −0.048 | 0.753 |
RA area | 0.401 | 0.006 |
iRAV | 0.273 | 0.070 |
VTI at rvot | −0.583 | 0.000 |
VRT/VTI at rvot | 0.197 | 0.196 |
TAPSE/PAPs | 0.101 | 0.508 |
PVRI | 0.003 | |
<0.20 | 8.88 (1.23) | |
>0.20 | 12.10 (2.55) |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Madonna, R.; Fabiani, S.; Morganti, R.; Forniti, A.; Biondi, F.; Ridolfi, L.; Iapoce, R.; Menichetti, F.; De Caterina, R. Exercise-Induced Pulmonary Hypertension Is Associated with High Cardiovascular Risk in Patients with HIV. J. Clin. Med. 2022, 11, 2447. https://doi.org/10.3390/jcm11092447
Madonna R, Fabiani S, Morganti R, Forniti A, Biondi F, Ridolfi L, Iapoce R, Menichetti F, De Caterina R. Exercise-Induced Pulmonary Hypertension Is Associated with High Cardiovascular Risk in Patients with HIV. Journal of Clinical Medicine. 2022; 11(9):2447. https://doi.org/10.3390/jcm11092447
Chicago/Turabian StyleMadonna, Rosalinda, Silvia Fabiani, Riccardo Morganti, Arianna Forniti, Filippo Biondi, Lorenzo Ridolfi, Riccardo Iapoce, Francesco Menichetti, and Raffaele De Caterina. 2022. "Exercise-Induced Pulmonary Hypertension Is Associated with High Cardiovascular Risk in Patients with HIV" Journal of Clinical Medicine 11, no. 9: 2447. https://doi.org/10.3390/jcm11092447