Sudden cardiac death is more common among patients with HIV, according to new research published in the New England Journal of Medicine.
The authors tracked data from all new deaths due to out-of-hospital cardiac arrest in San Francisco County from Feb. 1, 2011, to Sept. 16, 2016. The analysis was restricted to patients between the ages of 18 and 90 years old. Comparisons were made with a reference group of 505 patients without a confirmed HIV infection who died from presumed sudden cardiac death.
A total of 109 unexpected deaths due to out-of-hospital cardiac arrest were identified among patients with a confirmed HIV diagnosis. Sixty-one of those deaths “did not met WHO criteria for presumed sudden cardiac death,” the authors explained, and another patient was not included because autopsy data was not available.
Overall, of the 47 HIV-positive patients who died of a presumed sudden cardiac death, 47% died of a sudden death from arrhythmia. Noncardiac causes accounted for 51% and an acute myocardial infarction with wall rupture accounted for the other 2%.
The observed rate of presumed sudden cardiac death among people with HIV was 53.3 per 100,000 person-years. The rate for the reference group was 23.7 per 100,000 person-years. Sudden death caused by arrhythmia was technically more common among people with HIV, but it was not a statistically significant difference.
Myocardial fibrosis and death due to occult drug overdose were both more common among people with HIV, the authors added.
“We found a higher incidence of interstitial cardiac fibrosis among HIV-positive persons than among persons without known HIV infection,” wrote lead author Zian H. Tseng, MD, of the department of medicine at Zuckerberg San Francisco General Hospital, and colleagues. “Magnetic resonance imaging of the hearts of persons who are HIV-positive (but asymptomatic) shows a higher incidence of myocardial fibrosis, as assessed by late gadolinium enhancement, and decreased cardiac function. Late gadolinium enhancement is also higher in persons with nonischemic dilated cardiomyopathy and in survivors of cardiac arrest and is an independent prognostic factor for all-cause mortality beyond ejection fraction. Our finding provides histologic confirmation of these radiologic studies and links myocardial fibrosis to sudden death from arrhythmia in persons with HIV infection.”
The full analysis can be read here.
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