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Persons living with HIV (PLWH) have an augmented risk of cardiovascular disease, including atherosclerosis and myocardial dysfunction, despite effective viral suppression with antiretroviral therapy. Despite the majority of PLWH residing in sub-Saharan Africa, there are limited reports from the region on structural cardiovascular changes due to this residual risk.
The Early Structural Cardiovascular Disease, HIV, and Tuberculosis in East Africa (ASANTE) cross-sectional study will be conducted in a public hospital in Nairobi, Kenya. It will enrol 400 participants (50% women, 50% PLWH) to undergo cardiovascular phenotyping using multimodal imaging (coronary CT angiography (CCTA) and echocardiography) and banking of biological samples (whole blood, peripheral blood mononuclear cells, plasma and urine). We will define the prevalence of subclinical coronary atherosclerosis by CCTA and subclinical myocardial dysfunction by transthoracic echocardiography and evaluate both traditional and non-traditional risk factors, including endemic infections such as latent tuberculosis. This study will contribute important data on phenotypes of and risk factors for HIV-associated cardiovascular disease in this understudied region.
Ethical approval for the ASANTE study was granted by the University of Nairobi-Kenyatta National Hospital Ethical Review Committee, Nairobi, Kenya, and the University of Washington Institutional Review Board, USA. Results will be submitted for publication in peer-reviewed journals.
by Maureen A. Griffin, William T. N. Culp, Amandeep S. Chohan, Eric G. Johnson, Michelle A. Giuffrida, Carrie A. Palm, Robert B. Rebhun, Michael S. Kent
ObjectivesThe primary aim of this study was to evaluate the effects of vasodilator administration on CT angiography (CTA) prostatic artery diameter and peak opacification in dogs with prostatic carcinoma prior to prostatic artery embolization (PAE).
Materials and methodsA prospective clinical trial was performed. Ten dogs with naturally occurring prostatic carcinoma and no evidence of cardiovascular disease were enrolled. Each dog underwent multiphase CTA of the prostate before and after IV vasodilator (glyceryl trinitrate [GTN] or clevidipine butyrate [clevidipine]) administration, and cardiovascular parameters were monitored. PAE was performed the following day. Prostatic arterial anatomy was characterized by CTA. Prostatic artery lumen diameter and peak opacification were measured on pre- and post-vasodilator CTA by a blinded radiologist. The percent change of these measurements was calculated and assessed for significance.
ResultsGlyceryl trinitrate and clevidipine were administered in 5 dogs each with subsequent blood pressure reduction documented in all dogs. No significant difference was detected in prostatic artery diameter or peak opacification between pre- vs. post-vasodilator CTA. Good agreement in prostatic arterial branch number, origin, and course was documented between pre- and post-vasodilator CTA images.
Clinical significanceStudy findings do not support the routine use of vasodilator administration during pre-PAE CTA in dogs, though larger sample sizes and protocol alterations may be needed to detect a clinically relevant utility.
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