Electrocardiographic spatial QRS-T angle and incident cardiovascular disease in HIV-infected patients (from the Strategies for the Management of Antiretroviral Therapy [SMART] study)
- Authors:
-
- Dawood, Farah Z ;
- Khan, Faraaz ;
- Roediger, Mollie P ;
- Zhang, Zhu-Ming ;
- Swaminathan, Shobha ;
- Klinker, Hartwig ;
- Hoy, Jennifer ;
- Lundgren, Jens ;
- Neaton, James D ;
- Soliman, Elsayed Z ;
- Østergaard, L. ;
- Pedersen, C. ;
- Nielsen, Henrik Ib ;
- Hergens, L. ;
- Loftheim, I.R. ;
- Jensen, K.B. ;
- Raukas, M. ;
- Zilmer, K. ;
- Justinen, J. ;
- Ristola, M.
- 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. 118-124
- Keywords:
- Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; 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
- Main Research Area:
- Medical science
- Publication Status:
- Published
- Review type:
- Peer Review
- Submission year:
- 2013
- Scientific Level:
- Scientific
- ID:
- 233894713
