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Electrocardiographic spatial QRS-T angle and incident cardiovascular disease in HIV-infected patients (from the Strategies for the Management of Antiretroviral Therapy [SMART] study)

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Authors:
  • Dawood, Farah Z ;
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    Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston Salem, NC, USA.
  • Khan, Faraaz ;
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    unknown
  • Roediger, Mollie P ;
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    unknown
  • Zhang, Zhu-Ming ;
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    unknown
  • Swaminathan, Shobha ;
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    unknown
  • Klinker, Hartwig ;
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    unknown
  • Hoy, Jennifer ;
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    unknown
  • Lundgren, Jens D ;
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    Orcid logo0000-0001-8901-7850
    CHIP, Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, Københavns Universitet
  • Neaton, James D ;
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    unknown
  • Soliman, Elsayed Z
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    unknown
DOI:
10.1016/j.amjcard.2012.08.054
Abstract:
Widening of the electrocardiographic (ECG) spatial QRS-T angle has been predictive of cardiovascular disease (CVD) events in the general population. However, its prognostic significance in human immunodeficiency virus (HIV)-infected patients remains unknown. The spatial QRS-T angle was derived from the baseline resting 12-lead electrocardiogram of 4,453 HIV-infected patients aged 43.5 ± 9.3 years from the Strategies for Management of Antiretroviral Therapy (SMART) trial. CVD events were identified during a median follow-up of 28.7 months. Quartiles of the spatial QRS-T angle was calculated for men and women separately, and values in the upper quartile were considered as a widened angle (values >74° for women and >93° for men). A multivariate Cox proportional hazards analysis was used to examine the association between a widened baseline spatial QRS-T angle and incident CVD events. During 11,965 person-years of follow-up, 152 CVD events occurred at a rate of 1.27 events/100 person-years. The rate of CVD events in those with a widened spatial QRS-T angle was almost double the rate in those with a normal spatial QRS-T angle (rate ratio 1.94, 95% confidence interval 1.40 to 2.69; p 50% increased risk of CVD events compared to a normal spatial QRS-T angle (hazard ratio 1.53, 95% confidence interval 1.07 to 2.17; p = 0.02). No interaction was seen by SMART trial arm (p value for interaction = 0.37) or gender (p value for interaction = 0.84). In conclusion, a widened spatial QRS-T angle was independently predictive of CVD events in HIV-infected patients receiving antiretroviral therapy. This highlights the potential role of routine electrocardiography as a simple noninvasive CVD risk-screening tool in HIV-infected patients.
Type:
Journal article
Language:
English
Published in:
American Journal of Cardiology, 2013, Vol 111, Issue 1, p. 118-24
Keywords:
Adolescent; Adult; Anti-Retroviral Agents; Arrhythmias, Cardiac; Electrocardiography; Female; Follow-Up Studies; HIV; HIV Infections; Humans; Incidence; Male; Prognosis; Proportional Hazards Models; Prospective Studies; Risk Factors; Survival Rate; World Health; Young Adult; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural
Main Research Area:
Medical science
Publication Status:
Published
Review type:
Undetermined
Submission year:
2013
Scientific Level:
Scientific
ID:
233894713

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