A Preliminary Study on the Subclinical Vascular Injury of Coronary Artery in Asymptomatic HIV Infected Individuals Based on MR Vessel Wall Imaging (RF_SA_443)

The purpose of this study was to quantitatively evaluate the degree of subclinical coronary artery damage in asymptomatic HIV-infected individuals and to explore the relationship between this damage and HIV-related clinical features and diastolic dysfunction. Despite the fact that HIV-infected individuals may be asymptomatic, their cardiovascular system still faces potential risks. This study utilized MR vessel wall imaging technology to reveal potential coronary artery lesions in asymptomatic HIV-infected individuals and provide evidence for early intervention.

Methods:

A total of 144 asymptomatic HIV-infected individuals and 104 age- and sex-matched healthy controls were included in this study. All subjects underwent 3.0T magnetic resonance imaging scans to obtain myocardial and coronary artery wall images and assess coronary artery enhancement and diastolic dysfunction. Imaging analysis included T1 mapping of the myocardium and coronary artery wall enhancement imaging, with a focus on evaluating the original T1 value of the myocardium, the cellular extracellular volume fraction (ECV), the enhancement percentage of the coronary artery, and the contrast-to-noise ratio (CNR). In addition, all subjects had blood serum markers collected, including CD4+ T cell counts and viral load, and the relationship between coronary artery enhancement and diastolic dysfunction was explored using Pearson correlation analysis. The relationship between coronary artery wall enhancement and HIV-related clinical features was analyzed using a logistic regression model.

Results:

In asymptomatic HIV-infected individuals, the initial T1 value of the myocardium was significantly increased compared with the control group (1251±34 ms vs. 1193±23 ms, p < 0.01), while the ECV value did not show statistical significance (31.4±2.6 vs. 30.6±2.7, p = 0.12). The enhancement percentage and CNR of the coronary arteries in HIV-infected individuals were significantly higher than those in the control group (enhancement percentage: 9 [1-23] vs. 0 [0-0.01], p < 0.01; CNR: 3.5 [2.2-7.5] vs .05 [0-2.95], p < 0.01). Logistic regression analysis revealed that HIV-infected individuals with a lowest CD4+ T cell count below 200 cells/mm³ had a significantly increased risk of subclinical coronary artery damage (OR, 9 .61 [95% CI, -21 to -41]; p = 0.003), and a higher incidence of more severe damage (OR, -8 to -41; P=22) Pearson correlation analysis showed significant correlations between degree of coronary artery enhancement and indices of diastolic dysfunction including total strain (εs: R = 0.423, p < 0.001), passive strain (εe: R = 0.375 ,p< 0.001), positive strain rate(SRs: R= 0.404,p= 0.002 )and peak early negative strain rate(SRe: R=-0.488, p< 0.001 ).

Conclusion: This study shows that CMR is a non-invasive and highly accurate imaging technique that can effectively detect and quantify subclinical coronary artery lesions in HIV-infected individuals. Especially, HIV-infected individuals with the lowest CD4+ T cell counts have a significantly increased risk of subclinical coronary artery injury, emphasizing the importance of close monitoring and early intervention for these high-risk patients. Furthermore, the association between subclinical inflammation in the coronary arteries and impaired vasodilation function provides a new direction for future research. Further studies should combine longitudinal data to validate these findings and clarify their clinical implications.