Cardiovascular manifestations of Takayasu arteritis and their relationship to the disease activity: Analysis of 204 Korean patients at a single center (original) (raw)
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Takayasu's arteritis: a cause of prolonged arterial stiffness
Rheumatology, 2006
Objectives. Cardiovascular disease is a major cause of mortality and morbidity in patients with Takayasu's arteritis (TA). Increased arterial stiffness is an independent risk factor and predictor of cardiovascular mortality in a variety of diseases. Pulse wave velocity (PWV) and the augmentation index (AI) are used as clinical measurements of arterial stiffness. Methods. Data are presented from 10 patients with TA and 11 normal controls obtained between 2000 and 2004. Arterial compliance was assessed non-invasively by measurement of PWV, using the Complior Õ system, and calculation of the aortic AI. Results. TA patients (mean age 40.8±13.2 yr) were compared with a control group of healthy women from a parallel study (mean age 32.3±5.5 yr). The mean carotid-femoral PWV (PWV-CF) was higher in TA patients (P^0.03). In addition, both aortic AI derived from the radial artery (P^0.002) and carotid AI (P^0.03) were higher in TA patients compared with controls. PWV-CF did not correlate with CRP (r^À 0.23, P^0.23) or ESR (r^À 0.19, P^0.27). Similar results were obtained for the correlation of carotid-radial PWV with CRP (r^0.15, P^0.32) and ESR (r^0.33, P^0.14). Conclusions. Our data show that TA is associated with elevated arterial stiffness in the central aorta, which may persist when the disease is quiescent. These data suggest that PWV represents a means by which cardiovascular risk can be detected and monitored in TA, and highlights the importance of effective management of cardiovascular risk factors in these patients.
Echocardiographic Follow-Up of Patients with Takayasu's Arteritis: Five-Year Survival
Echocardiography, 2006
Takayasu's arteritis (TA) is a primary vasculitis that causes stenosis or occlusion, rarely aneurysm and distal ischemia. This study was undertaken to examine cardiovascular damage using echocardiography and determine the causes of morbid-mortality in Mexican Mestizo patients with TA. Seventy-six patients were studied by transthoracic echocardiography. Left ventricular diameters, parietal thickness, systolic function, and wall motion were analyzed, also, valvular lesions and aorta features were assessed. Thickness of the interventricular septum was 12 mm ± 3 , and that of posterior wall was 12 mm ± 2 (9-18). The average left ventricular diastolic diameter was 47 mm ± 7 (33-68) and the left ventricular systolic diameter 32 mm ± 8 . The left ventricular ejection fraction was of 57 ± 11%. Left ventricular concentric hypertrophy was found in 28 (50%) of the 56 hypertensive patients. The five-year survival of patients with left ventricular concentric hypertrophy was 80%, compared to 95% in patients without hypertrophy (P = 0.00). Abnormal wall motion was found in 15 patients. Thirty-one patients had aortic regurgitation, 19 had mitral regurgitation, 13 had tricuspid regurgitation, and 10 and pulmonary hypertension. Six patients had aneurysms of ascending aorta and 7 stenosis of descending aorta. Thirteen of 76 patients died (17%), 85% were hypertensive, and 9% also had acute myocardial infarction (AMI). Echocardiography, a noninvasive technique, shows a great utility in detection and follow-up of cardiovascular manifestations in patients with TA. New techniques, more sensitive toward detecting the early stages of left ventricular dysfunction, are promising to limit left ventricular hypertrophy development.
Aortic and coronary calcifications in Takayasu arteritis
Seminars in Arthritis and Rheumatism, 2013
Objectives: Atherosclerosis is well recognized in Takayasu arteritis (TAK) and the associated plaques tend to be more common in areas of arteritis. We now report arterial wall calcification in a large group of TAK patients and controls. We hypothesized that the degree of coronary artery calcification would point to a systemic effect of inflammation while that in the thoracic aorta more of local inflammation. Methods: A total of 47 patients with TAK, 43 patients with SLE and 70 healthy controls (HC) were studied. The presence of coronary artery and thoracic aorta calcifications (ToAC) was investigated by multi-detector computed tomography (MDCT). Atherosclerotic plaques in the carotid arteries were screened using B mode ultrasound. Results: The frequency of coronary artery calcification was significantly increased among patients with SLE as compared to the healthy controls while the increase in TAK did not reach statistical significance. There were more TAK patients with ToAC among the TAK as compared to the SLE patients [21/47 (45%) vs 10/43 (23%), P ¼ 0.033]. In addition, a circumferential type of calcification, vs a punctuate or linear type, was the more common type in 67% of patients with TAK whereas only the linear or punctuate type was seen in SLE patients and HC. SLE and TAK patients were found to have increased risk for carotid artery plaques. Among TAK patients, coronary artery calcification, ToAC and carotid artery plaques tend to be at sites of primary vasculitic involvement. Conclusions: There is increased atherosclerosis in TAK and SLE. Vessel wall inflammation seems to be also important in the atherosclerosis associated with TAK.
Atherosclerosis in Takayasu arteritis
Annals of the Rheumatic Diseases, 2006
Objective: Chronic inflammatory diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis are associated with accelerated atherosclerosis. We hypothesised that atherosclerosis may also be increased in Takayasu arteritis. Methods: The frequency of atherosclerotic plaques and the intima-media thickness (IMT) were investigated in 30 female patients with Takayasu arteritis (mean age (standard deviation), 35.4 (8.0) years), along with 45 sex-matched and age-matched patients with SLE (37.4 (6.8)) and 50 healthy controls (38.2 (5.7)). Plaques were scanned and IMT was measured at both sides of the common carotids, carotid bulb, and internal and external carotid arteries by B-mode ultrasonography. Traditional risk factors for atherosclerosis were also assessed. Results: Most of the atherosclerotic risk factors were comparable between patients with Takayasu arteritis and SLE. More atherosclerotic plaques were observed among patients with Takayasu arteritis (8/30; 27%) and those with SLE (8/45; 18%) than among the healthy controls (1/50; 2%; p = 0.005). Logistic regression analyses showed that the presence of a plaque was associated only with age in both Takayasu arteritis and SLE (p = 0.04 and 0.02, respectively). The mean overall IMT was significantly higher among patients with Takayasu arteritis (0.95¡0.31 mm) than among the patients with SLE (0.58¡0.10 mm) and the healthy controls (0.59¡0.08 mm; p,0.001). Conclusion: Patients with Takayasu arteritis have a high rate of atherosclerotic plaques, at least as frequent as that observed among patients with SLE.
Accelerated Atherosclerosis in Takayasu Disease: Case-Control Study
Open Journal of Internal Medicine, 2017
Aim: The aim of our study was to evaluate the atherosclerosis prevalence in Takayasu's disease. Patients and Method: We analyzed prospectively in a case-control study a group of 64 patients with Takayasu disease aged 41 years [±11.94], a group of 50 rhumatoide arthritis (RA) patients. All women aged 45 years [±10.27] and a control group with an average age of 44 years [±12.63]. We performed a measurement of the intima-media thickness (IMT) in carotid level and we looked for the presence of carotid, aortic and femoral atheroma. Results: We found more plaques of atheroma in the Takayasu group; the carotid intima-media thickness was significantly higher in the Takayasu group and the RA group compared with the control group. The mean IMT of the Takayasu group was 0.91 mm [±0.368]. It was 0.76 mm [±0.151] for the RA group. And 0.71 mm [±0.141] for the controls. (P: 0.000). CRP > 12 mg was identified as the most strongly associated with the development of accelerated atherosclerosis in Takayasu's disease and RA (p: 0.002) with an odds ratio of 14.5 (IC: 95%). Conclusion: The high prevalence of atherosclerosis discovered in Takayasu's disease is not explained by the traditional vascular risk factors. It is not also explained by the corticoids and immuno-suppression treatments. The systemic inflammation associated with parietal local inflammation, observed in Takayasu arteritis appears to be responsible of premature and accelerated atherosclerosis.
Thoracic Aorta Evaluation in Patients with Takayasu’s Arteritis by Transesophageal Echocardiography
Journal of the American Society of Echocardiography, 2006
There is no detailed description of thoracic aorta abnormalities assessed by transesophageal echocardiography (TEE) in patients with Takayasu's arteritis (TA). We aimed to evaluate these features in a series of patients in the chronic stage of TA. Fourteen patients (13 women, mean age 30 years) with inactive chronic TA were studied by TEE, and compared with 14 matched patients without aortic disease defined by TEE, who served as control subjects. In each segment of the thoracic aorta (ascending, arch, proximal, and distal descending aorta), we analyzed: (1) wall thickness; (2) diastolic diameters; and (3) systolic expansion index as a percentage of aortic expansibility. Increased circumferential wall thickness (71% of 55 aortic segments studied) and dilated segments (37%) were observed in patients with TA, with significant higher values than control subjects (P < .05). A global impairment of the elastic properties of the thoracic aorta of patients with TA was noted in 85% of the analyzed segments, expressed by a significant reduction of the systolic expansion index (3.9 +/- 3.8%) as compared with control subjects (14 +/- 5.7%; P < .005). TA as assessed by TEE is characterized by a remodeling process of the thoracic aorta with a marked and global decrease of aortic distensibility and concentric wall thickening. These features may be useful for noninvasive diagnosis of the chronic stage of TA by TEE.
Management of cardiac manifestations in Takayasu arteritis
Vessel Plus, 2020
Takayasu arteritis (TA) is a chronic vasculitis involving large vessels of unknown aetiology, a disease that is more common among the Asian population and predominant in young women. Cardiac manifestations include hypertension and involvement of the cardiac valves, myocardium and coronary arteries. Surgery on these patients is always a challenge given the tissue quality and the disease activity. They are prone to long-term complications such as restenosis and graft occlusion, hence requiring lifelong surveillance. The prevalence of coronary artery disease (CAD) in TA ranges from 9 to 11%. Coronary artery bypass grafting is preferred to percutaneous coronary intervention, as the latter has a high rate of restenosis and major adverse cardiovascular events. As left subclavian artery is commonly involved, saphenous vein graft is advised as a conduit rather than internal mammary artery. Other surgical procedures described for CAD are surgical angioplasty of the left main coronary artery and transaortic coronary ostial endarterectomy. Aortic regurgitation in TA has an incidence of approximately 20%. These patients tend to have prosthetic valve detachment, paravalvular leak or pseudoaneurysm at the anastomotic site. Further repair of these valves have a high rate of failure. Considering these facts, it is advisable to do an aortic root replacement for TA patients than to consider an aortic valve replacement or David's procedure.
Rheumatology, 2010
Objective. Disease Extent Index-Takayasu (DEI.Tak) is a new index developed for the follow-up of Takayasu's arteritis (TA), assessing only clinical findings without the requirement of imaging. We investigated the effectiveness of DEI.Tak in assessing disease activity and progression by comparing with physician's global assessment (PGA) and active disease criteria defined by Kerr et al. Methods. The initial DEI.Tak forms were filled in for 145 TA patients cross-sectionally to detect the baseline damage and after 29.8 (31) months (n = 105, 144 visits) only by including the new/worsening symptoms within the past 6 months. Results. At baseline, all patients had a DEI.Tak >0 [mean (S.D.): 7.6 (4.2)]. At this evaluation, 62% of the patients had active, 16.2% had persistent and 21.8% had inactive disease according to the PGA. At follow-up, in 69% of the patients the DEI.Tak score was 0. However, 14% of them were accepted as having active and 17% persistent disease according to PGA. In contrast, 18% with a DEI.Tak 5 1 were inactive according to PGA. Patients with active or persistent disease with PGA had higher DEI.Tak compared with inactives [1.3 (1.9), 1 (1.3) vs 0.2 (0.6), respectively; P < 0.001]. According to Kerr's criteria 27% were active. The total agreement between DEI.Tak and Kerr's criteria was 94% (= 0.85). Compared with PGA, Kerr's criteria had a total agreement of 74% and DEI.Tak 68%. Conclusion. During follow-up, most TA patients showed no clinical activity with DEI-Tak. Although the agreement between Kerr's criteria and DEI.Tak seemed very good, using Kerr's criteria instead of DEI.Tak increased the consistency with PGA, which could be explained by the influence of imaging data and acute-phase reactant levels on the physician's decisions.