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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Prevalence and Prognostic Significance of ECG Abnormalities in HIV-infected Patients: Results from the Strategies for Management of Antiretroviral Therapy (SMART) Study</title><author><name sortKey="Soliman, Elsayed Z" sort="Soliman, Elsayed Z" uniqKey="Soliman E" first="Elsayed Z" last="Soliman">Elsayed Z. Soliman</name><affiliation><nlm:aff id="A1">Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC</nlm:aff></affiliation></author><author><name sortKey="Prineas, Ronald J" sort="Prineas, Ronald J" uniqKey="Prineas R" first="Ronald J" last="Prineas">Ronald J. Prineas</name><affiliation><nlm:aff id="A1">Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC</nlm:aff></affiliation></author><author><name sortKey="Roediger, Mollie P" sort="Roediger, Mollie P" uniqKey="Roediger M" first="Mollie P" last="Roediger">Mollie P. Roediger</name><affiliation><nlm:aff id="A2">Department of Biostatistics, University of Minnesota, Minneapolis, MN</nlm:aff></affiliation></author><author><name sortKey="Duprez, Daniel A" sort="Duprez, Daniel A" uniqKey="Duprez D" first="Daniel A" last="Duprez">Daniel A. Duprez</name><affiliation><nlm:aff id="A3">Department of Medicine, University of Minnesota, Minneapolis, MN</nlm:aff></affiliation></author><author><name sortKey="Boccara, Franck" sort="Boccara, Franck" uniqKey="Boccara F" first="Franck" last="Boccara">Franck Boccara</name><affiliation><nlm:aff id="A4">Cardiology Department, Saint-Antoine University and Medical School, France</nlm:aff></affiliation></author><author><name sortKey="Boesecke, Christoph" sort="Boesecke, Christoph" uniqKey="Boesecke C" first="Christoph" last="Boesecke">Christoph Boesecke</name><affiliation><nlm:aff id="A5">National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia</nlm:aff></affiliation></author><author><name sortKey="Stephan, Christoph" sort="Stephan, Christoph" uniqKey="Stephan C" first="Christoph" last="Stephan">Christoph Stephan</name><affiliation><nlm:aff id="A6">HIV Treatment and Clinical Research Unit, Medical Department, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany</nlm:aff></affiliation></author><author><name sortKey="Hodder, Sally" sort="Hodder, Sally" uniqKey="Hodder S" first="Sally" last="Hodder">Sally Hodder</name><affiliation><nlm:aff id="A7">HIV/AIDS Program, Department of Medicine, University of Medicine and Dentistry of New Jersey, Newark, NJ</nlm:aff></affiliation></author><author><name sortKey="Stein, James H" sort="Stein, James H" uniqKey="Stein J" first="James H" last="Stein">James H. Stein</name><affiliation><nlm:aff id="A8">School of Medicine and Public Health, University of Wisconsin School of Medicine and Public Health, Madison, WI</nlm:aff></affiliation></author><author><name sortKey="Lundgren, Jens D" sort="Lundgren, Jens D" uniqKey="Lundgren J" first="Jens D" last="Lundgren">Jens D. Lundgren</name><affiliation><nlm:aff id="A9">Copenhagen HIV Programme (CHIP), State University Hospital and University of Copenhagen, Copenhagen, Denmark</nlm:aff></affiliation></author><author><name sortKey="Neaton, James D" sort="Neaton, James D" uniqKey="Neaton J" first="James D" last="Neaton">James D. Neaton</name><affiliation><nlm:aff id="A2">Department of Biostatistics, University of Minnesota, Minneapolis, MN</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">21145066</idno><idno type="pmc">3060290</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3060290</idno><idno type="RBID">PMC:3060290</idno><idno type="doi">10.1016/j.jelectrocard.2010.10.027</idno><date when="2010">2010</date><idno type="wicri:Area/Pmc/Corpus">001395</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001395</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Prevalence and Prognostic Significance of ECG Abnormalities in HIV-infected Patients: Results from the Strategies for Management of Antiretroviral Therapy (SMART) Study</title><author><name sortKey="Soliman, Elsayed Z" sort="Soliman, Elsayed Z" uniqKey="Soliman E" first="Elsayed Z" last="Soliman">Elsayed Z. Soliman</name><affiliation><nlm:aff id="A1">Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC</nlm:aff></affiliation></author><author><name sortKey="Prineas, Ronald J" sort="Prineas, Ronald J" uniqKey="Prineas R" first="Ronald J" last="Prineas">Ronald J. Prineas</name><affiliation><nlm:aff id="A1">Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC</nlm:aff></affiliation></author><author><name sortKey="Roediger, Mollie P" sort="Roediger, Mollie P" uniqKey="Roediger M" first="Mollie P" last="Roediger">Mollie P. Roediger</name><affiliation><nlm:aff id="A2">Department of Biostatistics, University of Minnesota, Minneapolis, MN</nlm:aff></affiliation></author><author><name sortKey="Duprez, Daniel A" sort="Duprez, Daniel A" uniqKey="Duprez D" first="Daniel A" last="Duprez">Daniel A. Duprez</name><affiliation><nlm:aff id="A3">Department of Medicine, University of Minnesota, Minneapolis, MN</nlm:aff></affiliation></author><author><name sortKey="Boccara, Franck" sort="Boccara, Franck" uniqKey="Boccara F" first="Franck" last="Boccara">Franck Boccara</name><affiliation><nlm:aff id="A4">Cardiology Department, Saint-Antoine University and Medical School, France</nlm:aff></affiliation></author><author><name sortKey="Boesecke, Christoph" sort="Boesecke, Christoph" uniqKey="Boesecke C" first="Christoph" last="Boesecke">Christoph Boesecke</name><affiliation><nlm:aff id="A5">National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia</nlm:aff></affiliation></author><author><name sortKey="Stephan, Christoph" sort="Stephan, Christoph" uniqKey="Stephan C" first="Christoph" last="Stephan">Christoph Stephan</name><affiliation><nlm:aff id="A6">HIV Treatment and Clinical Research Unit, Medical Department, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany</nlm:aff></affiliation></author><author><name sortKey="Hodder, Sally" sort="Hodder, Sally" uniqKey="Hodder S" first="Sally" last="Hodder">Sally Hodder</name><affiliation><nlm:aff id="A7">HIV/AIDS Program, Department of Medicine, University of Medicine and Dentistry of New Jersey, Newark, NJ</nlm:aff></affiliation></author><author><name sortKey="Stein, James H" sort="Stein, James H" uniqKey="Stein J" first="James H" last="Stein">James H. Stein</name><affiliation><nlm:aff id="A8">School of Medicine and Public Health, University of Wisconsin School of Medicine and Public Health, Madison, WI</nlm:aff></affiliation></author><author><name sortKey="Lundgren, Jens D" sort="Lundgren, Jens D" uniqKey="Lundgren J" first="Jens D" last="Lundgren">Jens D. Lundgren</name><affiliation><nlm:aff id="A9">Copenhagen HIV Programme (CHIP), State University Hospital and University of Copenhagen, Copenhagen, Denmark</nlm:aff></affiliation></author><author><name sortKey="Neaton, James D" sort="Neaton, James D" uniqKey="Neaton J" first="James D" last="Neaton">James D. Neaton</name><affiliation><nlm:aff id="A2">Department of Biostatistics, University of Minnesota, Minneapolis, MN</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of electrocardiology</title><idno type="ISSN">0022-0736</idno><idno type="eISSN">1532-8430</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title><p id="P1">It remains debated whether to include resting electrocardiogram (ECG) in the routine care of patients infected with Human immunodeficiency virus (HIV). This is largely because data are limited regarding the prevalence and prognostic significance of ECG abnormalities in HIV-infected patients.</p></sec><sec sec-type="methods" id="S2"><title>Methods</title><p id="P2">This analysis included 4518 HIV-infected patients (28% females and 29% blacks) from The Strategies for Management of Antiretroviral Therapy (SMART) study, a clinical trial aimed to compare two HIV treatment strategies. ECG abnormalities were classified using the Minnesota Code. Multivariable adjusted Cox proportional hazards analysis was used to examine the association between baseline ECG abnormalities and incident cardiovascular disease.</p></sec><sec id="S3"><title>Results</title><p id="P3">More than half of the participants (N=2325, 51.5%) had either minor or major ECG abnormalities. Minor ECG abnormalities (48.6%) were more common than major ECG abnormalities (7.7%). During a median follow-up of 28.7 months, 155 (3.4%) participants developed incident cardiovascular disease. After adjusting for the study treatment arms, the presence of major, minor, and either minor or major ECG abnormalities were significantly predictive of incident cardiovascular disease [Hazard ratio (95% Confidence Interval): 2.76 (1.74, 4.39), p<0.001; 1.58 (1.14, 2.20), p=0.006; 1.57 (1.14, 2.18), p=0.006, respectively]. However, after adjusting for demographics, common cardiovascular risk factors and HIV characteristics (full model), presence of major ECG abnormalities was still significantly predictive of cardiovascular disease [1.83 (1.12, 2.97), p=0.015)], but not minor or minor or major abnormalities taken together [1.26 (0.89, 1.79), p=0.18; 1.25 (0.89, 1.76), p=0.20, respectively]. Individual ECG abnormalities that significantly predicted cardiovascular disease in the fully adjusted model included major isolated ST/T abnormalities, major prolongation of QT interval, minor isolated ST/T and minor isolated Q/QS abnormalities.</p></sec><sec id="S4"><title>Conclusion</title><p id="P4">Nearly one in two of the HIV-infected patients in SMART study had ECG abnormalities; one in thirteen had major ECG abnormalities. Presence of ECG abnormalities, especially major ECG abnormalities was independently predictive of incident cardiovascular disease. These results suggest that the ECG could provide a convenient risk screening tool in HIV-infected patients.</p></sec></div></front></TEI><pmc article-type="research-article" xml:lang="EN"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">0153605</journal-id><journal-id journal-id-type="pubmed-jr-id">4710</journal-id><journal-id journal-id-type="nlm-ta">J Electrocardiol</journal-id><journal-title>Journal of electrocardiology</journal-title><issn pub-type="ppub">0022-0736</issn><issn pub-type="epub">1532-8430</issn></journal-meta><article-meta><article-id pub-id-type="pmid">21145066</article-id><article-id pub-id-type="pmc">3060290</article-id><article-id pub-id-type="doi">10.1016/j.jelectrocard.2010.10.027</article-id><article-id pub-id-type="manuscript">NIHMS246982</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Prevalence and Prognostic Significance of ECG Abnormalities in HIV-infected Patients: Results from the Strategies for Management of Antiretroviral Therapy (SMART) Study</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Soliman</surname><given-names>Elsayed Z</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Prineas</surname><given-names>Ronald J</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Roediger</surname><given-names>Mollie P</given-names></name><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Duprez</surname><given-names>Daniel A</given-names></name><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Boccara</surname><given-names>Franck</given-names></name><xref ref-type="aff" rid="A4">4</xref></contrib><contrib contrib-type="author"><name><surname>Boesecke</surname><given-names>Christoph</given-names></name><xref ref-type="aff" rid="A5">5</xref></contrib><contrib contrib-type="author"><name><surname>Stephan</surname><given-names>Christoph</given-names></name><xref ref-type="aff" rid="A6">6</xref></contrib><contrib contrib-type="author"><name><surname>Hodder</surname><given-names>Sally</given-names></name><xref ref-type="aff" rid="A7">7</xref></contrib><contrib contrib-type="author"><name><surname>Stein</surname><given-names>James H</given-names></name><xref ref-type="aff" rid="A8">8</xref></contrib><contrib contrib-type="author"><name><surname>Lundgren</surname><given-names>Jens D</given-names></name><xref ref-type="aff" rid="A9">9</xref></contrib><contrib contrib-type="author"><name><surname>Neaton</surname><given-names>James D</given-names></name><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><collab>on behalf of the SMART/INSIGHT study group</collab></contrib></contrib-group><aff id="A1"><label>1</label>Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC</aff><aff id="A2"><label>2</label>Department of Biostatistics, University of Minnesota, Minneapolis, MN</aff><aff id="A3"><label>3</label>Department of Medicine, University of Minnesota, Minneapolis, MN</aff><aff id="A4"><label>4</label>Cardiology Department, Saint-Antoine University and Medical School, France</aff><aff id="A5"><label>5</label>National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia</aff><aff id="A6"><label>6</label>HIV Treatment and Clinical Research Unit, Medical Department, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany</aff><aff id="A7"><label>7</label>HIV/AIDS Program, Department of Medicine, University of Medicine and Dentistry of New Jersey, Newark, NJ</aff><aff id="A8"><label>8</label>School of Medicine and Public Health, University of Wisconsin School of Medicine and Public Health, Madison, WI</aff><aff id="A9"><label>9</label>Copenhagen HIV Programme (CHIP), State University Hospital and University of Copenhagen, Copenhagen, Denmark</aff><author-notes><corresp id="CR1"><underline>Correspondence</underline>: Elsayed Z. Soliman MD, MSc, MS Epidemiological Cardiology Research Center (EPICARE) Department of Epidemiology and Prevention Wake Forest University School of Medicine 2000 West First St., Piedmont Plaza 2, Suite 505 Winston Salem, NC 27104 Phone: (336) 716-8632 Fax: (336) 716-0834 <email>esoliman@wfubmc.edu</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>28</day><month>10</month><year>2010</year></pub-date><pub-date pub-type="epub"><day>8</day><month>12</month><year>2010</year></pub-date><pub-date pub-type="ppub"><month>11</month><year>2011</year></pub-date><pub-date pub-type="pmc-release"><day>1</day><month>11</month><year>2012</year></pub-date><volume>44</volume><issue>6</issue><fpage>779</fpage><lpage>785</lpage><permissions><copyright-statement>© 2010 Elsevier Inc. All rights reserved.</copyright-statement><copyright-year>2010</copyright-year></permissions><abstract><sec id="S1"><title>Background</title><p id="P1">It remains debated whether to include resting electrocardiogram (ECG) in the routine care of patients infected with Human immunodeficiency virus (HIV). This is largely because data are limited regarding the prevalence and prognostic significance of ECG abnormalities in HIV-infected patients.</p></sec><sec sec-type="methods" id="S2"><title>Methods</title><p id="P2">This analysis included 4518 HIV-infected patients (28% females and 29% blacks) from The Strategies for Management of Antiretroviral Therapy (SMART) study, a clinical trial aimed to compare two HIV treatment strategies. ECG abnormalities were classified using the Minnesota Code. Multivariable adjusted Cox proportional hazards analysis was used to examine the association between baseline ECG abnormalities and incident cardiovascular disease.</p></sec><sec id="S3"><title>Results</title><p id="P3">More than half of the participants (N=2325, 51.5%) had either minor or major ECG abnormalities. Minor ECG abnormalities (48.6%) were more common than major ECG abnormalities (7.7%). During a median follow-up of 28.7 months, 155 (3.4%) participants developed incident cardiovascular disease. After adjusting for the study treatment arms, the presence of major, minor, and either minor or major ECG abnormalities were significantly predictive of incident cardiovascular disease [Hazard ratio (95% Confidence Interval): 2.76 (1.74, 4.39), p<0.001; 1.58 (1.14, 2.20), p=0.006; 1.57 (1.14, 2.18), p=0.006, respectively]. However, after adjusting for demographics, common cardiovascular risk factors and HIV characteristics (full model), presence of major ECG abnormalities was still significantly predictive of cardiovascular disease [1.83 (1.12, 2.97), p=0.015)], but not minor or minor or major abnormalities taken together [1.26 (0.89, 1.79), p=0.18; 1.25 (0.89, 1.76), p=0.20, respectively]. Individual ECG abnormalities that significantly predicted cardiovascular disease in the fully adjusted model included major isolated ST/T abnormalities, major prolongation of QT interval, minor isolated ST/T and minor isolated Q/QS abnormalities.</p></sec><sec id="S4"><title>Conclusion</title><p id="P4">Nearly one in two of the HIV-infected patients in SMART study had ECG abnormalities; one in thirteen had major ECG abnormalities. Presence of ECG abnormalities, especially major ECG abnormalities was independently predictive of incident cardiovascular disease. These results suggest that the ECG could provide a convenient risk screening tool in HIV-infected patients.</p></sec></abstract><kwd-group><kwd>HIV/AIDS</kwd><kwd>ECG</kwd><kwd>Cardiovascular Disease</kwd><kwd>SMART Study</kwd></kwd-group><contract-num rid="AI1">U01 AI042170-07
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