Exercise testing and single-photon emission computed tomography myocardial perfusion imaging to detect silent coronary heart disease in people with HIV

Objective: To evaluate the relevance of single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) combined with exercise testing, performed in asymptomatic people with HIV receiving effective antiretroviral therapy (ART), for detecting baseline silent coronary heart disease (SCHD) and predicting incident cardiac events. Design: Retrospective observational study conducted between November 2015 and July 2024 at Saint-Louis Hospital, Paris. Methods: We screened people with HIV with no history of coronary artery disease for SCHD using MPI combined with exercise testing. Patients with abnormal findings underwent coronary angiography. Baseline SCHD was defined as the presence of significant coronary stenosis confirmed by coronary angiography. Incident cardiac events during follow-up included incident SCHD, myocardial infarction, chest pain associated with significant coronary stenosis, and sudden death. Baseline risk factors associated with SCHD and cardiac events were assessed using univariate and multivariate analyses. Results: A total of 475 people with HIV were analyzed, with a median follow-up of 6 years. The median age was 56 years, 87.8% were male, 58.1% were current or ex-smokers, and 29.9% were on statins. The baseline prevalence of SCHD was 2.1% [95% confidence interval (CI): 1.1–4]. During follow-up, the incidence of cardiac events was 1.2 per 100 person-years (95% CI: 0.8–1.7). Only a combined positive MPI and exercise testing was associated with a significantly increased risk of SCHD and cardiac events [adjusted odds ratio (aOR) 4.0; 95% CI: 1.91–8.35; P < 0.001]. Conclusion: SPECT MPI combined with exercise testing can detect SCHD and may help identify people with HIV at increased cardiovascular risk.