Multi-Parametric Diagnostic Approach and Potential Markers of Early Onset Subclinical Cardiovascular Disease in a Cohort of Children, Adolescents and Young Adults Vertically Infected with HIV on cART

Background: HIV infection and lifelong cART are responsible of an increase in cardiovascular risk. The aim of this study was to describe the subclinical cardiovascular disease and to identify early markers of cardiovascular damage in adolescents and young adults vertically infected with HIV on cART, through an innovative multi-parametric approach. Methods: We enrolled 52 patients vertically infected with HIV. Demographic records, traditional cardiovascular risk factors, laboratory findings and echocardiographic measurements were collected in a one-year routine follow up. The echocardiographic examination included measurements of the 2D and 3D ejection fraction (EF), E/A ratio, E/E′ ratio, carotid intima media thickness (cIMT), flow-mediated dilation (FMD) and global longitudinal strain (GLS). Results: At the time of enrolment, all the patients were on cART therapy. The viral load was suppressed in 95% of them. EF was normal in 94.2% of patients (66 ± 7.2%), and GLS (mean value: −20.0 ± 2.5%) was reduced in 29% of patients. The cIMT mean value was higher than the 95th centile for sex and age in 73%, and FMD was impaired in 45% of patients. Clinically evident disease was found in three patients: dilative cardiomyopathy in one, thoracic-abdominal aneurysm Crawford type II with a bilateral carotid dilation in one and carotid plaque with 30% of stenosis in a third patient. Conclusions: This study confirms the presence of clinical and subclinical cardiovascular disease in a very young population vertically infected with HIV, underlining the importance of an early, multi-parametric cardiovascular follow up.

Primary Hyperparathyroidism is Associated with Shorter QTc Intervals, but not Arrhythmia

Context Primary hyperparathyroidism (PHPT) is associated with subclinical cardiovascular disease, but data regarding cardiac conduction abnormalities are limited. Objective and Design Retrospective cross-sectional comparison of cardiac conduction in patients with PHPT or thyroid disease (TD). Participants and Setting Patients ≥40 years old who underwent parathyroidectomy or thyroidectomy at a single tertiary institution from 2013-2018. Methods and Outcomes Demographics and pre-operative electrocardiogram (EKG) parameters were compared using the Mann-Whitney U, Chi Square tests, and linear regression. Results A total of 1,242 patients were included: 49.8% PHPT (n=619) and 50.2% TD (n=623). Median age was 60.5 years (IQR 53.6-67.9). Compared to controls, PHPT patients had higher median serum calcium [10.7 mg/dL (IQR 10.4-11.1) vs 9.5 mg/dL (IQR 9.3-9.8), p<0.001] as expected, as well as, a higher prevalence of hyperlipidemia (49% vs 36%, p<0.001) and hypertension (50.1% vs 42.2%, p<0.01). Based on EKG, there was no difference in PR interval or the prevalence of arrhythmia, atrioventricular block, ST segment/T wave changes, premature ventricular complexes, right bundle branch block or left bundle branch block after adjusting for covariates. The PHPT group had a lower mean corrected QT interval (414ms (+/- 24) vs 422ms (+/- 24), p<0.01), adjusted for covariates. Serum calcium predicted QTc independently of age, sex, and other covariates. Conclusions In the largest study to date, PHPT patients had shorter QTc intervals compared to TD controls, but no increased prevalence of arrhythmia based on pre-operative EKG.

The burden of subclinical cardiovascular disease in children and young adults with CKD and on dialysis

Introduction Cardiovascular disease (CVD) is a common cause of morbidity and mortality even in young people with chronic kidney disease (CKD). We examined structural and functional cardiovascular changes in patients with CKD stages 4-5 and on dialysis under 30 years of age. Methods 79 children and 21 young adults underwent cardiac CT for coronary artery calcification (CAC), ultrasound for carotid intima media thickness (cIMT), carotid-femoral pulse wave velocity (cfPWV), and echocardiography. Differences in structural [CAC, cIMT z-score, left ventricular mass index] and functional [carotid distensibility z-score, cfPWV z-score] measures were examined between CKD stages 4-5 and dialysis patients. Results Overall the cIMT z-score was raised (median 2.17, IQR 1.14-2.86) and 10 (10%) had CAC. 16/23(69.5%) of CKD4-5 and 68/77(88.3%) on dialysis had at least one structural or functional CV abnormality. There was no difference in the prevalence of structural abnormalities in CKD or dialysis cohorts, but functional abnormalities were more prevalent in patients on dialysis (p < 0.05). The presence of > 1 structural abnormality was associated with a 4.5-fold increased odds of > 1 functional abnormality (95% CI 1.3 to 16.6, p < 0.05). Patients with structural and functional abnormalities (cIMT z-score >2SD or distensibility <-2SD) had less carotid dilatation (lumen/wall cross sectional areas ratio) compared to those with normal cIMT and distensibility. Conclusion There is a high burden of subclinical cardiovascular disease in young CKD patients, with a greater prevalence of functional abnormalities in dialysis compared to CKD patients. Longitudinal studies are required to test these hypothesis generating data and define the trajectory of CV changes in CKD.