Stress echocardiography can help identify the risk of heart attack or death in patients with HIV, allowing for risk stratification of individuals into low- and high-risk groups, according to research published online in Circulation: Cardiovascular Imaging.
In a study of more than 300 HIV-positive patients, patients with an abnormal stress echo study had a 10 times greater risk of heart attack and death than the average population. The group also had more than three times the risk of heart attack and death when compared to HIV-negative patients with abnormal stress echo exams. Meanwhile, patients with normal exams had event rates comparable to the general population: less than 1% per year.
"Patients with an abnormal [stress echocardiography exam] have poor outcomes and may benefit from aggressive interventions," wrote senior author Dr. Farooq Chaudhry, of Columbia University College of Physicians and Surgeons, and colleagues. "Furthermore, an abnormal [stress echocardiography exam] provides incremental prognostic value over traditional clinical, stress electrocardiographic, and resting echocardiographic variables."
Patients with HIV face an increased risk of accelerated coronary artery disease and cardiovascular events. To assess the prognostic value of stress echocardiography, the researchers evaluated 311 HIV patients; 173 (56) received dobutamine stress echocardiography and 138 (44%) had exercise stress echocardiography (Circulation: Cardiovascular Imaging, July 12, 2011).
The study population had an average age of 52 and an average left ventricular ejection fraction of 54. Of the 311 patients, 230 (74%) were male.
Seventy-nine (26%) had abnormal stress echocardiography exams, while the remaining 232 had normal findings. In cases with abnormal results, 62 had ischemia.
Follow-up over an average of 2.9 years found 17 confirmed myocardial infarctions and 14 cardiac deaths in the group with abnormal exams. The average risk of heart attack and death was 12% each year. Meanwhile, only four events were found in the group with normal stress echocardiography studies.
Cumulative survival for HIV patients
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In other findings, the researchers determined that independent predictors of cardiac events included abnormal stress echocardiography exams (hazard ratio = 28.2, 95% confidence interval: 6.2-128, p < 0.0001) and the presence of any ischemia on stress echocardiography (hazard ratio = 3.4, 95% confidence interval: 1.3-8.6, p = 0.009).
Using a forward conditional Cox proportional hazards regression model, the study team calculated that stress echocardiography yielded incremental prognostic value over clinical, stress electrocardiographic, and resting echocardiographic variables (global Chi-square increased from 17.8 to 24.5 to 65 to 109, p < 0.05 across all groups).
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
