Severdija, Ryan

Abstract Objective People living with HIV have an increased risk of heart failure (HF). There are different subtypes of HF. Knowledge about the factors differentiating HF subtypes in people with HIV is limited but necessary to guide preventive measures and treatment. Methods A retrospective review of medical records was undertaken in people with HIV aged ≥18 years who received care at the University of Miami/Jackson Memorial HIV Clinic between January 2017 and November 2019 ( N = 1166). Patients with an echocardiogram available for review ( n = 305) were included. HF was defined as a documented diagnosis of any HF subtype ( n = 52). We stratified those with HF by their ejection fraction (EF) into HF with preserved EF (HFpEF), HF with borderline EF, or HF with reduced EF (HFrEF). Results The prevalence of HF was 4.5%. The cohort included 46.2% females and 75% self‐identified African Americans. Those with HF had a higher prevalence of hypertension, prior myocardial infarction, angina, coronary artery disease, percutaneous coronary intervention, coronary artery bypass grafting, diastolic dysfunction, and left ventricle hypertrophy. People with HIV with HF with borderline EF exhibited more coronary artery disease than those with HFpEF. Conclusions We characterize HF in people with HIV in South Florida and report the prevalence of HF and HF subtypes. Only a small percentage of patients had echocardiograms performed, suggesting an ongoing need for recognition of the increased risk of HF in people living with HIV, and raising the concern about lack of awareness contributing to underdiagnosis and missed treatment opportunities in this population.

Abstract Background Physical or emotional stress is the most common cause of Takotsubo cardiomyopathy (TS). The exact mechanism of TS remains unclear, and some possible mechanism include myocardial edema and inflammation, coronary vasospasm, microcirculatory dysfunction, catecholamine surge, and sympathetic overdrive. Recently, and consistent with the availability of coronary spasm provocative studies, data suggests that coronary artery vasospasm (CAVS) plays an essential role in the pathogenesis of TS. However, whether CAVS is a consequence or a primary cause of TS is still unclear. The clinical implications of concomitant TS and CAVS have not been studied. Purpose Describe differences in baseline characteristics, comorbidities, cardiovascular risk factors, in-hospital mortality, and outcomes of patients with TS and documented CAVS. Methods The US National Inpatient Database was queried from 2011 to 2019 for relevant ICD-9 and -10 diagnostic and procedural codes. We identified patients admitted with TS who had a coronary angiogram. We then excluded those who underwent coronary percutaneous coronary intervention (PCI), coronary artery bypass graft (CAGB) or had a diagnosis of myocarditis. We compared baseline characteristics and in-hospital outcomes of patients with TS with vs. without documented CAVS. Results We identified 136,732 patients admitted with TS, of which 1,112 (0.8%) had CAVS. We found that those patients with TS and CAVS were younger and less likely to have hypertension, diabetes, atrial fibrillation, hyperlipidemia, coronary artery disease, peripheral artery disease, chronic kidney disease, chronic obstructive pulmonary disease, a prior cancer diagnosis, and smoking history than those without CAVS. Conversely, they were more likely to be obese, have substance abuse disorder, a history of polycystic ovary syndrome, post-traumatic stress disorder, anxiety, history of migraines, and have had a prior myocardial infarction (MI). Regarding in-hospital outcomes, we did not find a significant difference in mortality between groups. Those with TS and CAVS were more likely to have a cardiac arrest, 2nd-degree AV block, ventricular fibrillation, ventricular tachycardia, and more likely to require ICD placement compared to those patients without CAVS. Conclusions Patients with TS and coronary vasospasm were younger, had fewer cardiovascular risk factors but were more likely to have had a prior MI than those without CAVS. We report no significant difference in mortality between groups. However, those with TS and CAVS were more likely to have hospitalizations complicated by cardiac arrest and significant arrhythmias like ventricular fibrillation, ventricular tachycardia, and 2nd-degree AV Block, which led to a higher need for ICD implantation. This large US nationwide retrospective study can provide hypotheses generating ideas for more extensive prospective studies to determine the frequency and role of CAVS in patients with TS.