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Wu Y, Wang J, Fu Z, Liu M, Xie W, Tao X, Huang Q, Zhai Z. "Guidezilla" extension catheter combined with balloon technique for treating pulmonary artery stenosis caused by Takayasu arteritis. J Interv Med 2023; 6:199-202. [PMID: 38312129 PMCID: PMC10831387 DOI: 10.1016/j.jimed.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 02/06/2024] Open
Abstract
Takayasu arteritis (TA) is a rare systemic vasculitis of the aorta and its primary branches, which usually occurs in young women. Due to its insidious onset and lack of specific symptoms, this disease can be easily misdiagnosed or missed. Approximately 50 % of the patients having TA with pulmonary artery involvement develop pulmonary hypertension (PH). The 3-year survival rate among patients with TA-related PH is lower than that among patients with TA alone. Early balloon pulmonary angioplasty (BPA) can improve the clinical symptoms and survival of patients with stable TA. To the best of our knowledge, this is the first case reported in the English literature in which a "Guidezilla" catheter was used during BPA to treat stenosis and occlusion of the pulmonary artery caused by Takayasu arteritis (TA).
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Affiliation(s)
- Yifan Wu
- National Center for Respiratory Medicine, Beijing, PR China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, PR China
- National Clinical Research Center for Respiratory Diseases, Beijing, PR China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
- Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, PR China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Jinzhi Wang
- National Center for Respiratory Medicine, Beijing, PR China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, PR China
- National Clinical Research Center for Respiratory Diseases, Beijing, PR China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
- Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, PR China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Zhihui Fu
- National Center for Respiratory Medicine, Beijing, PR China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, PR China
- National Clinical Research Center for Respiratory Diseases, Beijing, PR China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
- Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, PR China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, 100730, China
| | - Min Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Wanmu Xie
- National Center for Respiratory Medicine, Beijing, PR China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, PR China
- National Clinical Research Center for Respiratory Diseases, Beijing, PR China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
- Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, PR China
| | - Xincao Tao
- National Center for Respiratory Medicine, Beijing, PR China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, PR China
- National Clinical Research Center for Respiratory Diseases, Beijing, PR China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
- Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, PR China
- Chinese Academy of Medical Sciences Fuwai Hospital Center for Respiratory and Pulmonary Vascular Diseases, Beijing, 100037, China
| | - Qiang Huang
- National Center for Respiratory Medicine, Beijing, PR China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, PR China
- National Clinical Research Center for Respiratory Diseases, Beijing, PR China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
- Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, PR China
| | - Zhenguo Zhai
- National Center for Respiratory Medicine, Beijing, PR China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, PR China
- National Clinical Research Center for Respiratory Diseases, Beijing, PR China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
- Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, PR China
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Cheon JE, Kim HJ. Recurrent flash pulmonary edema in unilateral renal artery stenosis with contralateral kidney shrinkage: A case report. Medicine (Baltimore) 2023; 102:e35228. [PMID: 37747008 PMCID: PMC10519504 DOI: 10.1097/md.0000000000035228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/06/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
RATIONALE Flash pulmonary edema is a critical medical condition characterized by sudden and severe fluid accumulation in the lungs, which poses an immediate and life-threatening emergency. This can arise from a variety of underlying causes. This manuscript presents a case of recurrent pulmonary edema that was successfully managed through the insertion of a renal artery stent. PATIENT CONCERNS A 78-year-old woman visited the emergency room with recurrent acute dyspnea. Computed tomography renal angiography revealed renal artery stenosis of a single-functioning kidney. DIAGNOSES Flash pulmonary edema caused by renal artery stenosis of a functioning single kidney. INTERVENTIONS Percutaneous transluminal angioplasty and stenting were performed for the renal artery stenosis. OUTCOMES The patient's kidney function rapidly improved, and she has been free of flash pulmonary edema for 2 years. LESSONS Flash pulmonary edema can have various causes and can immediately be a life-threatening emergency. However, it can be treated with percutaneous revascularization if it is caused by renal artery stenosis. This case report reinforces the importance of accurate and immediate diagnosis when dealing with flash pulmonary edema. This case emphasizes the potential therapeutic benefit of renal artery stenting in the management of flash pulmonary edema caused by renal artery stenosis in patients with a single-functioning kidney.
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Affiliation(s)
- Ji Eun Cheon
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Hyo Jin Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Wawak M, Tekieli Ł, Badacz R, Pieniążek P, Maciejewski D, Trystuła M, Przewłocki T, Kabłak-Ziembicka A. Clinical Characteristics and Outcomes of Aortic Arch Emergencies: Takayasu Disease, Fibromuscular Dysplasia, and Aortic Arch Pathologies: A Retrospective Study and Review of the Literature. Biomedicines 2023; 11:2207. [PMID: 37626704 PMCID: PMC10452526 DOI: 10.3390/biomedicines11082207] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
Non-atherosclerotic aortic arch pathologies (NA-AAPs) and anatomical variants are characterized as rare cardiovascular diseases with a low incidence rate, below 1 case per 2000 population, but enormous heterogeneity in terms of anatomical variants, i.e., Takayasu disease (TAK) and fibromuscular dysplasia (FMD). In specific clinical scenarios, NA-AAPs constitute life-threatening disorders. METHODS In this study, 82 (1.07%) consecutive patients with NA-AAPs (including 38 TAKs, 26 FMDs, and 18 other AAPs) out of 7645 patients who underwent endovascular treatment (EVT) for the aortic arch and its side-branch diseases at a single institution between 2002 and 2022 were retrospectively reviewed. The recorded demographic, biochemical, diagnostic, operative, and postoperative factors were reviewed, and the functional outcomes were determined during follow-up. A systematic review of the literature was also performed. RESULTS The study group comprised 65 (79.3%) female and 17 (21.7%) male subjects with a mean age of 46.1 ± 14.9 years. Overall, 62 (75.6%) patients were diagnosed with either cerebral ischemia symptoms or aortic arch dissection on admission. The EVT was feasible in 59 (72%) patients, whereas 23 (28%) patients were referred for medical treatment. In EVT patients, severe periprocedural complications occurred in two (3.39%) patients, including one periprocedural death and one cerebral hyperperfusion syndrome. During a median follow-up period of 64 months, cardiovascular events occurred in 24 (29.6%) patients (5 deaths, 13 ISs, and 6 myocardial infarctions). Repeated EVT for the index lesion was performed in 21/59 (35.6%) patients, including 19/33 (57.6%) in TAK and 2/13 (15.4%) in FMD. In the AAP group, one patient required additional stent-graft implantation for progressing dissection to the iliac arteries at 12 months. A baseline white blood count (odds ratio [HR]: 1.25, 95% confidence interval [CI]: 1.11-1.39; p < 0.001) was the only independent prognostic factor for recurrent stenosis, while a baseline hemoglobin level (HR: 0.73, 95%CI: 0.59-0.89; p = 0.002) and coronary involvement (HR: 4.11, 95%CI: 1.74-9.71; p = 0.001) were independently associated with a risk of major cardiac and cerebral events according to the multivariate Cox proportional hazards regression analysis. CONCLUSIONS This study showed that AAPs should not be neglected in clinical settings, as it can be a life-threatening condition requiring a multidisciplinary approach. The knowledge of prognostic risk factors for adverse outcomes may improve surveillance in this group of patients.
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Affiliation(s)
- Magdalena Wawak
- Department of Interventional Cardiology, The John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
| | - Łukasz Tekieli
- Department of Interventional Cardiology, The John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
| | - Rafał Badacz
- Department of Interventional Cardiology, The John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Kraków, Poland
| | - Piotr Pieniążek
- Department of Interventional Cardiology, The John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Kraków, Poland
| | - Damian Maciejewski
- Department of Interventional Cardiology, The John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
| | - Mariusz Trystuła
- Department of Vascular and Endovascular Surgery, The John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland;
| | - Tadeusz Przewłocki
- Department of Interventional Cardiology, The John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Kraków, Poland
| | - Anna Kabłak-Ziembicka
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Kraków, Poland
- Noninvasive Cardiovascular Laboratory, The John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
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Nan N, Pan L, Dong R, Song X. Mismatch of systematic and local inflammatory activity in Takayasu arteritis with coronary involvement: a case report. Eur Heart J Case Rep 2023; 7:ytad346. [PMID: 37554963 PMCID: PMC10406451 DOI: 10.1093/ehjcr/ytad346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/17/2023] [Accepted: 07/19/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Accurate evaluation of the activity stage in Takayasu arteritis (TA) is important for the revascularization of TA with coronary artery involvement (TA-CAD). Here, we report the case of a patient with a mismatch of systemic and local inflammatory activity, leading to 13 times the need for recurrent coronary revascularization. CASE SUMMARY A 31-year-old woman with a family history of coronary artery disease underwent percutaneous coronary intervention (PCI) for critical ostial lesions. This patient was identified with Numano Type V TA and she underwent optimal medical therapy and PCIs. Her clinical inflammatory markers were quickly normalized. However, in-stent restenosis events recurred every 3 months. Virtual-histology intravascular ultrasound (VH-IVUS) and 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) confirmed local vascular inflammation. A coronary artery bypass graft (CABG) was also conducted. Before this procedure, both the CABG grafts and the anastomotic areas were accurately assessed with 18FDG-PET/CT. Eventually, this patient remained both angina- and event-free for 2 years post-CABG. DISCUSSION The persistence of TA activity despite normal clinical inflammatory markers is uncommon as is the need for recurrent revascularization after appropriate PCI management. Intracoronary imaging and 18FDG-PET/CT play a critical role in assessing TA activity as well as precisely guiding CABG grafts and anastomosis sites to prevent graft failure.
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Affiliation(s)
- Nan Nan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Cardiovascular Wisdom Diagnosis and Treatment, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Lili Pan
- Department of Rheumatology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ran Dong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiantao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Cardiovascular Wisdom Diagnosis and Treatment, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China
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Weyand CM. Large Vessel Vasculitides. Clin Immunol 2023. [DOI: 10.1016/b978-0-7020-8165-1.00060-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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de Oliveira JCS, dos Santos AM, de Aguiar MF, Gonçalves J, de Souza AWS, Pereira RMR, Shinjo SK. Characteristics of Older Patients with Takayasu's Arteritis: A Two-Center, Cross-Sectional, Retrospective Cohort Study. Arq Bras Cardiol 2022; 120:e20220463. [PMID: 36629607 PMCID: PMC9833251 DOI: 10.36660/abc.20220463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/28/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Few studies have assessed elderly patients with Takayasu's arteritis (TAK). OBJECTIVES To evaluate the progression of TAK in different age groups and its possible effects on drug treatment and disease activity. METHODS This cross-sectional and retrospective cohort study included 66 TAK patients. Patients were interviewed and data of the 12 preceding months were collected from electronic medical records. The patients were divided into four quartiles according to current age and compared for clinical and laboratory data, treatment, comorbidities, disease status, and functional status. Statistical significance was set at p<0.05. RESULTS The groups were Q1(22-36 years, n=16), Q2(37-42 years, n=18), Q3(43-49 years, n=17), and Q4(51-66 years, n=15). The frequency of patients with disease activity, fatigue, comorbidities and vascular impairments, and the TAK disease extent index were also comparable between the groups. With age, disease duration was longer (p=0.001), fewer patients used prednisone (Q1:43.8%, Q2:33.3%, Q3:11.8%, and Q4:6.7%; p=0.049) and immunosuppressive drugs [Q1:100.0%, Q2:66.7%, Q3:58.8%, and Q4:46.7%; Q1 versus Q3 (p=0.043), and Q1 versus Q4 (p=0.005) in post-hoc analyses], and patients had greater functional status impairment (Q2 versus Q3, p=0.003). In addition, the levels of disease damage, new TAK symptoms, and complications in the preceding 12 months were not different between the groups. CONCLUSIONS Older patients with TAK require minimal drug treatment, and have greater impairment of functional status, which may be attributed to aging-related factors.
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Affiliation(s)
- João Calvino Soares de Oliveira
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilDivisão de Reumatologia – Hospital das Clínicas HCFMUSP – Faculdade de Medicina – Universidade de São Paulo, São Paulo, SP – Brasil
| | - Alexandre Moura dos Santos
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilDivisão de Reumatologia – Hospital das Clínicas HCFMUSP – Faculdade de Medicina – Universidade de São Paulo, São Paulo, SP – Brasil
| | - Mariana Freitas de Aguiar
- Divisão de ReumatologiaUniversidade Federal de São PauloSão PauloSPBrasilDivisão de Reumatologia – Universidade Federal de São Paulo – UNIFESP, São Paulo, SP – Brasil
| | - Jucier Gonçalves
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilDivisão de Reumatologia – Hospital das Clínicas HCFMUSP – Faculdade de Medicina – Universidade de São Paulo, São Paulo, SP – Brasil
| | - Alexandre Wagner Silva de Souza
- Divisão de ReumatologiaUniversidade Federal de São PauloSão PauloSPBrasilDivisão de Reumatologia – Universidade Federal de São Paulo – UNIFESP, São Paulo, SP – Brasil
| | - Rosa Maria R. Pereira
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilDivisão de Reumatologia – Hospital das Clínicas HCFMUSP – Faculdade de Medicina – Universidade de São Paulo, São Paulo, SP – Brasil, In memorium
| | - Samuel Katsuyuki Shinjo
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilDivisão de Reumatologia – Hospital das Clínicas HCFMUSP – Faculdade de Medicina – Universidade de São Paulo, São Paulo, SP – Brasil
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Chandrashekhara SH, Gulati GS, Sharma S, Kumar S, Chaudhary SK, Jagia P, Seth S, Gupta SK, Khan M. Role of Cardiac MRI Including LGE, T1 and T2 Mapping in the Assessment of Cardiac Involvement in Patients of Nonspecific Aorto-arteritis: A Prospective Study. Indian J Radiol Imaging 2022; 32:441-450. [DOI: 10.1055/s-0042-1754362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Objective Nonspecific aorto-arteritis (NSAA) may involve the myocardium in the form of edema and fibrosis. We conducted this study to investigate role of cardiac MRI including late gadolinium enhancement (LGE), T1 and T2 mapping in the assessment of cardiac involvement in NSAA.
Methods and Materials Over the period between 2016 and 2019, 36 patients with NSAA presenting with uncontrolled hypertension, left ventricular dysfunction, congestive cardiac failure, or tachyarrhythmia were included in the study. We also had 16 voluntary control patients for providing normal T1 and T2 mapping values.
Results The average age of patients was 27.1 years and the majority were females. MRI is more sensitive than echocardiography in the detection of LV dysfunction and RWMA. Out of 36 patients, 10 (27.8%) had LGE. The most common pattern of midmyocardial enhancement was present in 5 out of 10 patients. Five (13.8%) patients show mid-myocardial enhancement, followed by epicardial enhancement, which was seen in four (11.11%) patients. The values of post-gad T1 mapping values were significantly lower than pre-gad T1 mapping values. At a cut-off global native T1 mapping value of 1019 milliseconds had the sensitivity of 83.3% and specificity of 81.2% in detecting an abnormal T1 map. No significant association of MRI contrast enhancement with elevated ESR and CRP levels. There was no significant relation of myocardial T2 mapping values between NSAA and control groups.
Conclusion Quantitative tissue characterization in the myocardium with native T1 mapping values help in the detection of cardiac involvement in patients with NSAA. T1 mapping may provide incremental value in the assessment of myocardial involvement in NSAA in addition to LGE imaging.
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Affiliation(s)
- S H. Chandrashekhara
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Gurpreet Singh Gulati
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjiv Sharma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv Kumar Chaudhary
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Jagia
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Seth
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Mahroof Khan
- Department of Biostatastics, All India Institute of Medical Sciences, New Delhi, India
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Iwakura T, Takanashi S, Masuda A, Hayashida M, Haraguchi G, Nanasato M, Isobe M, Shimokawa T. Coronary ostial angioplasty for juvenile Takayasu arteritis involving the coronary artery using external iliac artery grafts. Gen Thorac Cardiovasc Surg 2022; 70:1005-1008. [PMID: 35690990 PMCID: PMC9663377 DOI: 10.1007/s11748-022-01838-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/25/2022] [Indexed: 11/26/2022]
Abstract
Takayasu arteritis can affect the coronary ostia, leading to myocardial ischemia. Coronary ostial angioplasty effectively treats coronary artery ostial lesions associated with Takayasu arteritis. We present a case of juvenile Takayasu arteritis with bilateral subclavian artery occlusions treated with a novel coronary artery ostial angioplasty using the external iliac artery.
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Affiliation(s)
- Tomohiro Iwakura
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, 3-16-1, Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan.
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, 3-16-1, Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan
| | - Akio Masuda
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, 3-16-1, Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan
| | - Miyu Hayashida
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan
| | - Go Haraguchi
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan
| | - Mitsuaki Isobe
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, 3-16-1, Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan
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Sugihara T, Nakaoka Y, Uchida HA, Yoshifuji H, Maejima Y, Watanabe Y, Amiya E, Tanemoto K, Miyata T, Umezawa N, Manabe Y, Ishizaki J, Shirai T, Nagafuchi H, Hasegawa H, Miyamae T, Niiro H, Ito S, Ishii T, Isobe M, Harigai M. Establishing Clinical Remission Criteria and the Framework of a Treat-To-Target Algorithm for Takayasu arteritis: Results of a Delphi Exercise Carried out by an Expert Panel of the Japan Research Committee of the Ministry of Health, Labour, and Welfare for intractable vasculitis. Mod Rheumatol 2021; 32:930-937. [PMID: 34850081 DOI: 10.1093/mr/roab081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/04/2021] [Accepted: 09/11/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To develop a proposal for remission criteria and a framework for a treat-to-target (T2T) algorithm for Takayasu arteritis (TAK). METHODS A study group of the large-vessel vasculitis group of the Japanese Research Committee of the Ministry of Health, Labour, and Welfare for Intractable Vasculitis (JPVAS) consists of 10 rheumatologists, 5 cardiologists, 1 nephrologist, 1 vascular surgeon, 1 cardiac surgeon, and 2 pediatric rheumatologists. A Delphi survey of remission criteria items was circulated among the study group over 4 reiterations. To develop the T2T algorithm, the study group conducted four face-to-face meetings and two rounds of Delphi together with 3 patients. RESULTS Initial literature review resulted in a list of 117 candidate items for remission criteria, of which 56 items with a mean score of ≥4 (0-5) were extracted including disease activity domains and treatment/comorbidity domains. The study group provided six overarching principles for the T2T algorithm, two recommendations on treatment goals, five on evaluation of disease activity and imaging findings including PET-CT, and two on treatment intensification. CONCLUSIONS We developed a T2T algorithm and proposals for standardized remission criteria by means of a Delphi exercise. These will guide future evaluation of different TAK treatment regimens.
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Affiliation(s)
- Takahiko Sugihara
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Division of Rheumatology and Allergy, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan.,Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Haruhito A Uchida
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiko Watanabe
- First Department of Physiology, Kawasaki Medical School, Kurashiki, Japan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, Tokyo, Japan.,Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Tokyo, Japan
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Japan
| | - Tetsuro Miyata
- Department of Medical Education, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Natsuka Umezawa
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Manabe
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan.,Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Jun Ishizaki
- Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Tsuyoshi Shirai
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroko Nagafuchi
- Division of Rheumatology and Allergy, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hitoshi Hasegawa
- Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Takako Miyamae
- Pediatric Rheumatology, Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Hiroaki Niiro
- Department of Medical Education, Kyushu University, Fukuoka, Japan
| | - Shuichi Ito
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
| | - Tomonori Ishii
- Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Japan
| | | | - Masayoshi Harigai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Plasma apolipopotein C-2 elevation is associated with Takayasu arteritis. Sci Rep 2021; 11:18958. [PMID: 34556808 PMCID: PMC8460645 DOI: 10.1038/s41598-021-98615-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/13/2021] [Indexed: 11/20/2022] Open
Abstract
Takayasu arteritis (TAK) is an autoimmune systemic arteritis of unknown etiology. Although a number of investigators have attempted to determine biomarkers for diagnosing TAK, there exist no specific serological markers of this intractable disease. We undertook the exploration of novel serological markers which could be useful for an accurate diagnosis of TAK using an unbiased proteomics approach. The purified plasma samples from untreated patients with TAK and healthy individuals were separated by two-dimensional electrophoresis. The differentially expressed protein spots were detected by gel comparison and identified using matrix-assisted laser desorption/ionization time-of-flight/time-of-flight mass spectrometry (MS). Next, we validated plasma concentrations of identified proteins by enzyme-linked immunosorbent assay (ELISA). Two-dimensional electrophoresis and numerical analysis revealed 19 spots and 3 spot clusters whose sum of the sample averages was ≥ 0.01, and the average concentrations were ≥ 1.5 times in the patient group compared with the control group. Among them, 10 spots and spot clusters that met the condition of the average spot concentration being 2.5 times more than that in the control group were selected. After processing these spots using MS and conducting MS/MS ion search, we identified 10 proteins: apolipoprotein C-2 (ApoC-2), actin, apolipoprotein A-1, complement C3, kininogen-1, vitronectin, α2-macroglobulin, 14–3–3 protein ζ/δ, complement C4, and inter-α-trypsin inhibitor heavy chain H4 isoform 1 precursor. Finally, ELISA demonstrated that plasma ApoC-2 level was significantly elevated in patients with TAK compared with that in healthy individuals. Thus, ApoC-2 would be a promising candidate biomarker for TAK diagnosis.
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11
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Andreoli C, Biscottini E, Helou J, Crusco F, Marchetti F, Scarpignato M. A giant isolated right coronary aneurism. BJR Case Rep 2021; 7:20200208. [PMID: 35047200 PMCID: PMC8749390 DOI: 10.1259/bjrcr.20200208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/11/2021] [Accepted: 02/28/2021] [Indexed: 12/02/2022] Open
Abstract
A previously healthy 32-year-old female hailing from Mexico presented to the emergency department with rectorrhagia. Caseating granulomas were detected on histopathological analysis from cecum ulcerative lesions. A purified protein derivative skin test resulted positive. In order to exclude pulmonary tubercolosis, a CT lung scan was performed: a rounded and voluminous mass, located above the right atrioventricular cardiac junction, was unexpectedly revealed. Further, a cardiac magnetic resonance and a coronary angiography disclosed a giant (5 × 4,8 cm) isolated aneurysm of proximal right coronary artery with severe thrombotic layering. The patient was treated with isoniazid, rifampin, ethambutol, and pyrazinamide; after approximately 2 months of treatment, she had complete resolution of cecal lesions. Anticoagulant oral therapy with warfarin was started and the patient was submitted to coronary artery grafting bypass surgery.
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Affiliation(s)
- Chiara Andreoli
- Department of Cardiology, S.G.Battista Hospital, Foligno (PG), Italy
| | - Emilia Biscottini
- Department of Cardiology, S.G.Battista Hospital, Foligno (PG), Italy
| | - Johny Helou
- Department of Cardiology, S.G.Battista Hospital, Foligno (PG), Italy
| | - Federico Crusco
- Radiology Department, S.M. della Misericordia Hospital, Perugia, Italy
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12
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Naraoka S, Uchiyama H, Yano T, Mikami T, Harada R, Kuroda Y, Toda Y, Muranaka A, Sugawara T, Hasegawa T, Miura T, Kawaharada N. Case Report: Disappearance of Coronary Anastomotic Aneurysm by Steroid Therapy in Takayasu Arteritis: Pseudorepair of Pseudoaneurysm? Front Cardiovasc Med 2021; 8:683216. [PMID: 34150873 PMCID: PMC8212995 DOI: 10.3389/fcvm.2021.683216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Takayasu arteritis (TA) is a large vessel vasculitis of unknown etiology characterized by chronic inflammatory changes of the aorta and its major branches. Complications such as anastomotic aneurysm and valve detachment have been reported in active TA patients who received aortic valve replacement and graft replacement of aorta. Case Summary:A 61-year-old man with a history of emergency aortic valve replacement and patch closure of the noncoronary sinus of Valsalva due to acute heart failure induced by acute aortic regurgitation and ruptured sinus of Valsalva 4 years ago was referred for exertional dyspnea. Dilatation of the sinus of Valsalva together with protrusion of the right sinus of Valsalva and ostial stenosis of the left coronary artery were newly found by computed tomography (CT). A Bentall operation with concomitant coronary artery bypass grafting was successfully performed with a composite graft. Diagnosis of TA was made on the basis of histological analyses of the resected sinus of Valsalva, though other arterial manifestations were not detected by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography. Three months later, a follow-up study revealed left coronary ostial pseudoaneurysm at the anastomotic site together with strong 18F-FDG uptake, leading to commencement of steroid therapy. Eight months later, disappearance of left coronary ostial pseudoaneurysm was found by a follow-up CT scan. Conclusion: This is a rare TA case in whom spontaneous resolution of coronary anastomotic aneurysm by steroid therapy was found without reconstructive surgery.
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Affiliation(s)
| | | | - Toshiyuki Yano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - Takuma Mikami
- Department of Cardiovascular Surgery, Sapporo, Japan
| | - Ryo Harada
- Department of Cardiovascular Surgery, Sapporo, Japan
| | - Yosuke Kuroda
- Department of Cardiovascular Surgery, Sapporo, Japan
| | - Yuki Toda
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - Atsuko Muranaka
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - Taro Sugawara
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tadashi Hasegawa
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
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13
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Chandrashekhara SH, Gulati GS, Sharma S, Jagia P, Kumar S, Choudhary S. Comparison Between Time-Resolved Magnetic Resonance Angiography and Diagnostic Digital Subtraction Angiography in the Vascular Assessment of Nonspecific Aorto-Arteritis Patients: A Prospective Study. Vasc Endovascular Surg 2021; 55:586-592. [PMID: 33882744 DOI: 10.1177/15385744211010593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Nonspecific aortoarteritis (NSAA) is a chronic inflammatory vasculitis involving aorta and its branches. We conducted a study prospectively to compare time resolved magnetic resonance angiography (MRA) with diagnostic digital subtraction angiography (DSA) for the vascular assessment in the patients of NSAA. MATERIALS AND METHODS Seventeen patients of NSAA were recruited in the study over the period of 3 years. Contrast enhanced MRA using Time-resolved angiography With Interleaved Stochastic Trajectories (TWIST) sequence and diagnostic DSA were performed in these 17 patients. RESULTS The majority of the patients were young (median age was 25 years, range 8 to 46 years) and 11 patients were females. Erythrocyte sedimentation rate (ESR) was elevated in 9 patients and C-reactive protein (CRP) was elevated in 6 patients. Most commonly involved vessels in our patients were right renal artery (14 patients), abdominal aorta (12 patients) and left renal artery (11 patients). Left and right subclavian arteres were involved in 10 and 6 patients respectively. The sensitivity and specificity of time-resolved MRA using TWIST sequence is 100% as compared to DSA in the assessment of major vessels such as aorta, arch vessels, celiac artery and superior mesenteric artery. However, the sensitivity and specificity of time resolved MRA in the evaluation of renal arteries and vertebral arteries were 100%, 71.4% and 85.7%, 33.3% respectively. No significant association of MRI contrast enhancement with erythrocyte sedimentation rate (p = 1.00) and C-reactive protein (p = 0.600). CONCLUSION Time resolved MRA images obtained using TWIST sequence were as qualitative as DSA images and can noninvasively evaluate the vascular involvement in NSAA patients.
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Affiliation(s)
| | - Gurpreet Singh Gulati
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjiv Sharma
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Jagia
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv Choudhary
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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Pulse wave velocity, carotid intima media thickness and flow-mediated dilation in Takayasu arteritis: a systematic review. ACTA ACUST UNITED AC 2021; 6:e79-e84. [PMID: 34027216 PMCID: PMC8117071 DOI: 10.5114/amsad.2021.105390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/16/2021] [Indexed: 11/17/2022]
Abstract
Introduction Takayasu arteritis (TA) is a chronic vasculitis associated with an increased cardiovascular risk. The measurement of pulse wave velocity (PWV), carotid artery intima-media thickness (CIMT) and flow-mediated dilatation (FMD) are generally used for evaluating the cardiovascular risk. The application of these measurements to TA patients remains undetermined. Material and methods Clinical studies that reported the PWV, CIMT and FMD levels in TA patients, which were published prior to 2021, were summarized using PubMed. Results Fifteen studies were eligible. Overall, in TA patients, the PWV and CIMT levels were significantly higher and the FMD levels were significantly lower compared to controls. Part of the studies showed that the disease activity of TA was significantly associated with the PWV, CIMT or FMD levels. Conclusions The PWV, CIMT and FMD measurements could be useful for evaluating the cardiovascular risk in TA patients. Further studies to determine the proper use of these measurements are warranted.
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15
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Aghayev A, Steigner ML. Systemic vasculitides and the role of multitechnique imaging in the diagnosis. Clin Radiol 2021; 76:488-501. [PMID: 33812649 DOI: 10.1016/j.crad.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/02/2021] [Indexed: 11/17/2022]
Abstract
Vasculitis, a systemic disease characterised by inflammation of the blood vessels, remains challenging to diagnose and manage. Vessel size has been the basis for classifying systemic vasculitides. Imaging plays a vital role in diagnosing this challenging disease. This review article aims (a) to summarise up-to-date literature in this field, as well as include classification updates and (b) to review available imaging techniques, recent advances, and emphasis on imaging findings to diagnose large vessel vasculitides.
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Affiliation(s)
- A Aghayev
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - M L Steigner
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Keleşoğlu Dinçer AB, Kılıç L, Erden A, Kalyoncu U, Hazirolan T, Kiraz S, KaradaĞ Ö. Imaging modalities used in diagnosis and follow-up of patients with Takayasu’s arteritis. Turk J Med Sci 2021; 51:224-230. [PMID: 33155792 PMCID: PMC7991884 DOI: 10.3906/sag-2005-70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/05/2020] [Indexed: 11/24/2022] Open
Abstract
Background/aim Takayasu’s arteritis (TA) is a rare, large-vessel vasculitis of unknown etiology, affecting aortic arch, and its main branches. Noninvasive imaging methods are frequently used in diagnosis and follow-up in Takayasu’s arteritis. Studies investigating optimal timing of follow up imaging are rare. This study is aimed to investigate the radiologic changes in vascular involvements of Takayasu’s arteritis patients one year after diagnosis. Materials and methods Database of our Vasculitis Center was analyzed retrospectively and 97 patients were included into the study. Demographic, clinical, radiological, and therapeutic findings of patients were recorded. Patients with follow-up imaging after approximately one year of diagnosis were recruited into further analysis. Radiological changes and the effect of different immunosuppressive agents on vascular involvements were investigated. Results Mean age and disease duration of patients were 43.0 and 9.0 years. The most commonly used imaging methods/modalities for the diagnosis of TA were computer tomography-angiography (CT-Ang) (58.8%), magnetic resonance-angiography (MR-Ang) (29.9%), and doppler ultrasonography (11.3%). Subclavian and common carotid arteries were the most frequently involved vessels. Fifty-three patients underwent follow-up imaging after one year of diagnosis and, in 64% of patients, same imaging method had been used. MR-Ang (62.3%) and CT-Ang (35.9%) were the most preferred follow-up imaging studies. Sixty-eight percent of patients had stable vascular involvement, 28% had progression, and 4% had regression. No difference was found in radiological changes regarding patients with usage of different immunosuppressive agents (P = 0.634). There was no association between the change in serum acute phase reactants and radiological disease activity. Conclusion The most commonly used imaging modality for the diagnosis of TA was CT-Ang, whereas MR-Ang was the most preferred for follow-up. Almost 30% of TA patients in our Vasculitis Center had progression at around one year concordant with previous literature. A follow-up imaging at around one year of treatment seems feasible in management of TA.
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Affiliation(s)
| | - Levent Kılıç
- Department of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Abdulsamet Erden
- Department of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Umut Kalyoncu
- Department of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Tuncay Hazirolan
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sedat Kiraz
- Department of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ömer KaradaĞ
- Department of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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17
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Mahajan S, Behera UC, Pravabati SL, Shah M, Padhy SK, Kelgaonkar A. Pulseless and blindness - An ophthalmologist's role in diagnosing Takayasu arteritis: Case series and brief review of literature. Eur J Ophthalmol 2021; 31:3525-3531. [PMID: 33579172 DOI: 10.1177/1120672121990577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To study the initial presenting symptoms of Takayasu arteritis in unsuspecting patients. METHODS The underlying systemic condition was suspected in five subjects at a tertiary eye care center based on their ocular features. Similar reports in the literature were collated and analyzed for the common presenting features of undiagnosed Takayasu arteritis. RESULTS The most common presenting ophthalmic symptoms were vision loss (86.8%), ocular pain (21.1%), eye redness (18.4%), and photophobia (5.3%). There were no reports of glaucoma at presentation. Pupillary abnormalities (42.1%), microaneurysms in retinal mid-periphery (42.1%) and venous engorgement (28.9%) were the most common presenting signs. Despite systemic symptoms such as headache, dizziness, fatigue, weakness, arm claudication, fever, anorexia, weight loss, and syncope in 76.3% of cases, the patients in this series had never sought medical care before developing ocular symptoms. CONCLUSION Takayasu arteritis may remain latent until the ophthalmic complications compel the patient to seek medical attention. Hence, ophthalmologists need to be aware of the seemingly innocuous presentations of the disease.
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Affiliation(s)
- Snigdha Mahajan
- Retina-Vitreous Service, L V Prasad Eye Institute, Patia, Bhubaneswar, Odisha, India
| | - Umesh Chandra Behera
- Retina-Vitreous Service, L V Prasad Eye Institute, Patia, Bhubaneswar, Odisha, India
| | - Savla Laxmi Pravabati
- Retina-Vitreous Service, L V Prasad Eye Institute, Patia, Bhubaneswar, Odisha, India
| | - Miloni Shah
- Retina-Vitreous Service, L V Prasad Eye Institute, Patia, Bhubaneswar, Odisha, India
| | - Srikanta Kumar Padhy
- Retina-Vitreous Service, L V Prasad Eye Institute, Patia, Bhubaneswar, Odisha, India
| | - Anup Kelgaonkar
- Retina-Vitreous Service, L V Prasad Eye Institute, Patia, Bhubaneswar, Odisha, India
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Isobe M, Maejima Y, Saji M, Tateishi U. Evaluation of tocilizumab for intractable Takayasu arteritis and 18F-fluorodeoxyglucose-positron emission tomography for detecting inflammation under tocilizumab treatment. J Cardiol 2021; 77:539-544. [PMID: 33451862 DOI: 10.1016/j.jjcc.2020.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/09/2020] [Accepted: 11/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although high-dose glucocorticoids are effective in suppressing active inflammation of Takayasu arteritis (TAK), many patients experience relapse during tapering of glucocorticoids. Recently, the interleukin-6 receptor antibody, tocilizumab (TCZ), was reported to be effective for steroid-resistant TAK. However, there are no objective ways of diagnosing TAK recurrence because TCZ suppresses inflammatory biomarkers. OBJECTIVES To investigate the efficacy of TCZ at 1-year follow-up and of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography for detection of recurrence of inflammation during TCZ treatment. METHODS AND RESULTS We treated 19 patients with refractory TAK with TCZ. TCZ was discontinued in 2 cases because of side effects. Abatement of arteritis symptoms along with reduction of glucocorticoid dosage was achieved in 12 patients, resulting in a remission induction rate of 70.6%. The dosage of glucocorticoid was reduced from 16.1 ± 10.2 mg to 3.8 ± 1.7 mg at 1 year (p<0.001) in these patients. In the remaining 5 patients, glucocorticoid tapering led to exacerbation of symptoms and glucocorticoid dose had to be increased. FDG-PET scan results closely matched clinical course in all 5 patients with recurrence even during TCZ treatment, while the scan was negative for the remaining 12 patients. CONCLUSIONS TCZ injection provides robust steroid-sparing effect and improvement of inflammation without significant adverse effects. Recurrence of inflammation can be detected by FDG-PET even during TCZ treatment.
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Affiliation(s)
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan
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19
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Gelves-Meza J, Higuera SA, Bustos J, Forero JF, Medina HM, Salazar G. Severe Aortic Regurgitation and Left Main Coronary Artery Ostial Stenosis in a 21-Year-Old Woman: What's Going On? CASE (PHILADELPHIA, PA.) 2020; 4:512-517. [PMID: 33376844 PMCID: PMC7756182 DOI: 10.1016/j.case.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
TA is a progressive, relapsing large-vessel vasculitis. TA usually affects the aorta and its major branches. TA can cause LMCA or ostial lesions in young adults. Involvement of the aorta in TA can cause AR of varying degrees. Surgical rather than percutaneous revascularization produces better results in TA.
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Affiliation(s)
- Julian Gelves-Meza
- Department of Cardiology, Fundación Cardioinfantil/Instituto de Cardiología, Bogotá, Colombia.,Division of Cardiovascular Imaging, Department of Cardiology, Fundación Cardioinfantil/Instituto de Cardiología, Bogotá, Colombia
| | - Sergio A Higuera
- Department of Cardiology, Fundación Cardioinfantil/Instituto de Cardiología, Bogotá, Colombia.,Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Jorge Bustos
- Department of Cardiology, Fundación Cardioinfantil/Instituto de Cardiología, Bogotá, Colombia
| | - Julian F Forero
- Department of Cardiology, Fundación Cardioinfantil/Instituto de Cardiología, Bogotá, Colombia.,Division of Cardiovascular Imaging, Department of Cardiology, Fundación Cardioinfantil/Instituto de Cardiología, Bogotá, Colombia
| | - Hector M Medina
- Department of Cardiology, Fundación Cardioinfantil/Instituto de Cardiología, Bogotá, Colombia.,Division of Cardiovascular Imaging, Department of Cardiology, Fundación Cardioinfantil/Instituto de Cardiología, Bogotá, Colombia
| | - Gabriel Salazar
- Department of Cardiology, Fundación Cardioinfantil/Instituto de Cardiología, Bogotá, Colombia.,Division of Cardiovascular Imaging, Department of Cardiology, Fundación Cardioinfantil/Instituto de Cardiología, Bogotá, Colombia
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20
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The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res 2020; 42:1235-1481. [PMID: 31375757 DOI: 10.1038/s41440-019-0284-9] [Citation(s) in RCA: 1020] [Impact Index Per Article: 255.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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21
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Wang H, Zhang Y, Shen Z, Fang L, Liu Z, Zhang S. Comparing the effects of different management strategies on long-term outcomes for significant coronary stenosis in patients with Takayasu arteritis. Int J Cardiol 2020; 306:1-7. [DOI: 10.1016/j.ijcard.2020.02.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/05/2020] [Accepted: 02/18/2020] [Indexed: 02/02/2023]
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22
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Berti A, Bond M, Volpe A, Felicetti M, Bortolotti R, Paolazzi G. Practical approach to vasculitides in adults: an overview of clinical conditions that can mimic vasculitides closely. ACTA ACUST UNITED AC 2020. [DOI: 10.4081/br.2020.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Primary systemic vasculitides are rare diseases affecting blood vessel walls. The type and patterns of distribution of the organs affected usually reflect the size of the vessels predominantly involved, and the patterns of clinical manifestations are generally useful to reach a specific diagnosis. However, presenting symptoms may lack adequate specificity for a prompt diagnosis, leading to a diagnostic (and therapeutic) delay, often causing irreversible damage to the affected organs. Due to their rarity and variable clinical presentation, the diagnosis of primary vasculitides could be challenging for physicians. Vasculitis mimickers, i.e. the clinical conditions that could be likely mistaken for vasculitides, need to be carefully ruled out, especially before starting the immunosuppressive therapy. We present here a practical approach to the diagnosis of primary systemic vasculitides involving large, medium and small size vessels, and reviewed most of the conditions that could mimic primary systemic vasculitides.
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23
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Cui X, Qin F, Song L, Wang T, Geng B, Zhang W, Jin L, Wang W, Li S, Tian X, Zhang H, Cai J. Novel Biomarkers for the Precisive Diagnosis and Activity Classification of Takayasu Arteritis. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2020; 12:e002080. [PMID: 30645172 DOI: 10.1161/circgen.117.002080] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Establishing the diagnosis and determining disease activity of Takayasu arteritis (TA) remains challenging. Novel biomarkers might help to solve this problem. METHODS In the screening phase, by using large-scale protein arrays detecting samples from 90 subjects (TA active, 29; TA inactive 31; and controls, 30). In the validation phase, by using enzyme-linked immunosorbent assay (ELISA), potential biomarkers for TA diagnosis, and activity classification were measured in independent cohorts, respectively. RESULTS In the screening phase, 18 cytokines significantly differentially enriched between TA patients and controls and another 15 cytokines significantly differentially enriched between TA patient in active and inactive status were identified (adjusted P<0.05). In the validation phase, TIMP (tissue inhibitor of metalloproteinases)-1 was identified as a specific biomarker for TA diagnosis that a cutoff value of 221.86 μg/L could provide a specificity of 89.58% and a positive predictive value of 0.92. Meanwhile, we found it unreliable to use a single biomarker for TA activity classification. Considering this, we further built a logistic regression model based on multiple cytokines, including CA (cancer antigen) 125, FLRG (follistatin-related protein), IGFBP (insulin-like growth factor-binding protein)-2, CA15-3, GROa (growth-regulated alpha protein), LYVE (lymphatic vessel endothelial hyaluronic acid receptor)-1, ULBP (UL16-binding protein)-2, and CD (cluster of differentiation) 99, with an area under the curve reaching 0.909 for discriminating TA activity status. CONCLUSIONS This study suggested TIMP-1 as a specific biomarker for TA diagnosis with a cutoff value of 221.86 μg/L. Furthermore, we provided a logistic regression model based on 8 biomarkers for the precisive activity classification of TA with an area under the curve of 0.909.
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Affiliation(s)
- Xiao Cui
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Diseases, National Center for Cardiovascular Diseases (X.C., F.Q., L.S., B.G., W.Z., L.J., W.W., S.L., H.Z., J.C.), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R. China.,Cardiovascular Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China (X.C.)
| | - Fang Qin
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Diseases, National Center for Cardiovascular Diseases (X.C., F.Q., L.S., B.G., W.Z., L.J., W.W., S.L., H.Z., J.C.), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R. China.,Department of Cardiology, Chongqing Cardiac Arrhythmias Therapeutic Service Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China (F.Q.)
| | - Lei Song
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Diseases, National Center for Cardiovascular Diseases (X.C., F.Q., L.S., B.G., W.Z., L.J., W.W., S.L., H.Z., J.C.), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R. China
| | - Tian Wang
- Department of Rheumatology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, P.R. China (T.W.)
| | - Bin Geng
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Diseases, National Center for Cardiovascular Diseases (X.C., F.Q., L.S., B.G., W.Z., L.J., W.W., S.L., H.Z., J.C.), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R. China
| | - Weili Zhang
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Diseases, National Center for Cardiovascular Diseases (X.C., F.Q., L.S., B.G., W.Z., L.J., W.W., S.L., H.Z., J.C.), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R. China
| | - Ling Jin
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Diseases, National Center for Cardiovascular Diseases (X.C., F.Q., L.S., B.G., W.Z., L.J., W.W., S.L., H.Z., J.C.), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R. China
| | - Wenjie Wang
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Diseases, National Center for Cardiovascular Diseases (X.C., F.Q., L.S., B.G., W.Z., L.J., W.W., S.L., H.Z., J.C.), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R. China
| | - Shuangyue Li
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Diseases, National Center for Cardiovascular Diseases (X.C., F.Q., L.S., B.G., W.Z., L.J., W.W., S.L., H.Z., J.C.), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R. China
| | - Xinping Tian
- Department of Rheumatology, Peking Union Medical College Hospital (X.T.), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R. China
| | - Huimin Zhang
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Diseases, National Center for Cardiovascular Diseases (X.C., F.Q., L.S., B.G., W.Z., L.J., W.W., S.L., H.Z., J.C.), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R. China
| | - Jun Cai
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Diseases, National Center for Cardiovascular Diseases (X.C., F.Q., L.S., B.G., W.Z., L.J., W.W., S.L., H.Z., J.C.), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R. China
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Isobe M, Amano K, Arimura Y, Ishizu A, Ito S, Kaname S, Kobayashi S, Komagata Y, Komuro I, Komori K, Takahashi K, Tanemoto K, Hasegawa H, Harigai M, Fujimoto S, Miyazaki T, Miyata T, Yamada H, Yoshida A, Wada T, Inoue Y, Uchida HA, Ota H, Okazaki T, Onimaru M, Kawakami T, Kinouchi R, Kurata A, Kosuge H, Sada KE, Shigematsu K, Suematsu E, Sueyoshi E, Sugihara T, Sugiyama H, Takeno M, Tamura N, Tsutsumino M, Dobashi H, Nakaoka Y, Nagasaka K, Maejima Y, Yoshifuji H, Watanabe Y, Ozaki S, Kimura T, Shigematsu H, Yamauchi-Takihara K, Murohara T, Momomura SI. JCS 2017 Guideline on Management of Vasculitis Syndrome - Digest Version. Circ J 2020; 84:299-359. [PMID: 31956163 DOI: 10.1253/circj.cj-19-0773] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Koichi Amano
- Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University
| | - Yoshihiro Arimura
- Department of Rheumatology and Nephrology, Kyorin University School of Medicine.,Internal Medicine, Kichijoji Asahi Hospital
| | - Akihiro Ishizu
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University
| | - Shuichi Ito
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University
| | - Shinya Kaname
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine
| | | | - Yoshinori Komagata
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine
| | - Kimihiro Komori
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Kei Takahashi
- Department of Pathology, Toho University Ohashi Medical Center
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
| | - Hitoshi Hasegawa
- Department of Hematology, Clinical Immunology, and Infectious Diseases, Ehime University Graduate School of Medicine
| | - Masayoshi Harigai
- Department of Rheumatology, School of Medicine, Tokyo Women's Medical University
| | - Shouichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki
| | | | - Tetsuro Miyata
- Vascular Center, Sanno Hospital and Sanno Medical Center
| | - Hidehiro Yamada
- Medical Center for Rheumatic Diseases, Seirei Yokohama Hospital
| | | | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Graduate School of Medical Sciences, Kanazawa University
| | | | - Haruhito A Uchida
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Hideki Ota
- Department of Advanced MRI Collaboration Research, Tohoku University Graduate School of Medicine
| | - Takahiro Okazaki
- Vice-Director, Shizuoka Medical Center, National Hospital Organization
| | - Mitsuho Onimaru
- Division of Pathophysiological and Experimental Pathology, Department of Pathology, Graduate School of Medical Sciences, Kyushu University
| | - Tamihiro Kawakami
- Division of Dermatology, Tohoku Medical and Pharmaceutical University
| | - Reiko Kinouchi
- Medicine and Engineering Combined Research Institute, Asahikawa Medical University.,Department of Ophthalmology, Asahikawa Medical University
| | - Atsushi Kurata
- Department of Molecular Pathology, Tokyo Medical University
| | | | - Ken-Ei Sada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Eiichi Suematsu
- Division of Internal Medicine and Rheumatology, National Hospital Organization, Kyushu Medical Center
| | - Eijun Sueyoshi
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Takahiko Sugihara
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Hitoshi Sugiyama
- Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Mitsuhiro Takeno
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine
| | - Naoto Tamura
- Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine
| | | | - Hiroaki Dobashi
- Division of Hematology, Rheumatology and Respiratory Medicine Department of Internal Medicine, Faculty of Medicine, Kagawa University
| | - Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute
| | - Kenji Nagasaka
- Department of Rheumatology, Ome Municipal General Hospital
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University
| | | | - Shoichi Ozaki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Hiroshi Shigematsu
- Clinical Research Center for Medicine, International University of Health and Welfare
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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25
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Tezuka D, Maejima Y, Sasano T, Isobe M. Diagnostic Role and Feasibility of 18F-FDG PET for Assessing Takayasu Arteritis: Diagnostic Efficacy of Quantifying 18F-FDG Uptake. ANNALS OF NUCLEAR CARDIOLOGY 2020; 6:74-80. [PMID: 37123485 PMCID: PMC10133926 DOI: 10.17996/anc.20-00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/30/2020] [Accepted: 07/22/2020] [Indexed: 05/02/2023]
Abstract
Takayasu arteritis (TAK) is classified as large-vessel vasculitis caused by inflammation. It is often difficult to identify on clinical examination, and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) plays an indispensable role in diagnosing TAK by detecting the location and grade of the inflammatory lesions. The clinical utility of 18F-FDG PET has been established by clinical evidence, and 18F-FDG PET was added to the Japanese national health insurance listing in April 2018. In TAK, 18F-FDG uptake shows typical findings and is easily distinguished, except from physiological uptake. Particularly, the clinical significance of 18F-FDG PET is that can present not only with stenosis but also without stenosis in the arteries, which means that therapeutic intervention is possible before irreversible stenosis develops in the arteries. Additionally, 18F-FDG PET has superior diagnostic accuracy because it allows quantitative analysis using the maximum standardized uptake value. The analysis is used for the assessment of disease activity of TAK and can be utilized for therapeutic intervention in case of repeating remission during the follow-up term.
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Affiliation(s)
- Daisuke Tezuka
- Department of Cardiovascular Medicine, Advanced Imaging Center Yaesu Clinic, Japan
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan
- Reprint requests and correspondence: Daisuke Tezuka, MD, PhD, Department of Cardiovascular Medicine, Advanced Imaging Center Yaesu Clinic, AIC Yaesu Clinic Building, 2-1-18, Nihonbashi, Chuo-ku, Tokyo, 103-0027, Japan / E-mail:
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan
- Department of Life Sciences and Bio-informatics, Tokyo Medical and Dental University, Japan
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26
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Tokunaga C, Nakajima H, Kaneyuki D, Takazawa A, Izumida H, Hayashi J, Tochii M, Yoshitake A, Asakura T, Iguchi A. Ischemic Cardiomyopathy Due to Localized Takayasu Arteritis Treated by Heart Transplantation Following Left Ventricular Assisted Device Implantation: A Case Report. Transplant Proc 2019; 51:3174-3177. [DOI: 10.1016/j.transproceed.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/24/2019] [Indexed: 10/25/2022]
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27
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Tamura N, Maejima Y, Matsumura T, Vega RB, Amiya E, Ito Y, Shiheido-Watanabe Y, Ashikaga T, Komuro I, Kelly DP, Hirao K, Isobe M. Single-Nucleotide Polymorphism of the MLX Gene Is Associated With Takayasu Arteritis. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2019; 11:e002296. [PMID: 30354298 DOI: 10.1161/circgen.118.002296] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Takayasu arteritis (TAK) is an autoimmune systemic arteritis of unknown pathogenesis. Genome-wide association studies revealed that single-nucleotide polymorphisms in the MLX gene encoding the MLX (Max-like protein X) transcription factor are significantly associated with TAK in Japanese patients. MLX single-nucleotide polymorphism rs665268 is a missense mutation causing the Q139R substitution in the DNA-binding site of MLX. METHODS To elucidate the hypothesis that the single-nucleotide polymorphism of the MLX gene plays a critical role in the development of TAK, we conducted clinical and laboratory analyses. RESULTS We show that rs665268 significantly correlated with the severity of TAK, including the number of arterial lesions and morbidity of aortic regurgitation; the latter may be attributed to the fact that MLX mRNA expression was mostly detected in the aortic valve. Furthermore, the Q139R mutation caused structural changes in MLX, which resulted in enhanced formation of a heterodimer with MondoA, upregulation of TXNIP (thioredoxin-interacting protein) expression, and increase in the activity of the NLRP3 (NACHT, LRR, and PYD domains-containing protein 3) inflammasome and cellular oxidative stress. Furthermore, autophagy, which negatively regulates inflammasome activation, was suppressed by the Q139R mutation in MLX. The MLX-Q139R mutant significantly induced macrophage proliferation and macrophage-endothelium interaction, which was abolished by the treatment with SBI-477, an inhibitor of MondoA nuclear translocation. Our findings suggest that the Q139R substitution in MLX plays a crucial role in the pathogenesis of TAK. CONCLUSIONS MLX-Q139R mutation plays a crucial role in the pathogenesis of TAK through promoting inflammasome formation.
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Affiliation(s)
- Natsuko Tamura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.T., Y.M., Y.I., Y.S.-W., T.A., K.H., M.I.)
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.T., Y.M., Y.I., Y.S.-W., T.A., K.H., M.I.)
| | - Takayoshi Matsumura
- Department of Cardiovascular Medicine, The University of Tokyo, Japan (T.M., E.A., I.K.)
| | - Rick B Vega
- Translational Research Institute for Diabetes and Metabolism, Florida Hospital, Orlando (R.B.V.)
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, The University of Tokyo, Japan (T.M., E.A., I.K.)
| | - Yusuke Ito
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.T., Y.M., Y.I., Y.S.-W., T.A., K.H., M.I.)
| | - Yuka Shiheido-Watanabe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.T., Y.M., Y.I., Y.S.-W., T.A., K.H., M.I.)
| | - Takashi Ashikaga
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.T., Y.M., Y.I., Y.S.-W., T.A., K.H., M.I.)
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Japan (T.M., E.A., I.K.)
| | - Daniel P Kelly
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.P.K.)
| | - Kenzo Hirao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.T., Y.M., Y.I., Y.S.-W., T.A., K.H., M.I.)
| | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.T., Y.M., Y.I., Y.S.-W., T.A., K.H., M.I.).,Sakakibara Heart Institute, Japan Research Promotion Society for Cardiovascular Diseases, Tokyo (M.I.)
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28
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Pfister R, Messe M, Niclauss L, Kirsch M, Haller C, Delay D. 18-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography to Guide Aortic Arch Replacement in Relapsing Polychondritis. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2019; 7:18-21. [PMID: 31330548 PMCID: PMC6645908 DOI: 10.1055/s-0039-1687903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Relapsing polychondritis (RP) is a rare progressive autoimmune disease. The cardiovascular system is rarely involved. The authors report the case of a young woman with RP aortic arch aneurysm and symptomatic cerebral vessels stenosis. A positron emission tomography-computed tomography (PET–CT) indicated areas with activity and guided the surgery. Aortic arch with proximal vessels was successfully replaced. The PET–CT may be useful to assess the risks and determine healthy zones for potential anastomotic sites.
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Affiliation(s)
- Raymond Pfister
- Department of Cardiovascular Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,Department of Cardiac Surgery, Valais Hospital, Sion, Switzerland
| | - Maria Messe
- Department of Neurology, Valais Hospital, Sion, Switzerland
| | - Lars Niclauss
- Department of Cardiovascular Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,Department of Cardiac Surgery, Valais Hospital, Sion, Switzerland
| | - Matthias Kirsch
- Department of Cardiovascular Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Claude Haller
- Department of Vascular Surgery, Valais Hospital, Sion, Switzerland
| | - Dominique Delay
- Department of Cardiovascular Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,Department of Cardiac Surgery, Valais Hospital, Sion, Switzerland
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29
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Yano T, Osanami A, Shimizu M, Katano S, Nagano N, Kouzu H, Koyama M, Muranaka A, Harada R, Doi H, Kawaharada N, Miura T. Utility and safety of tocilizumab in Takayasu arteritis with severe heart failure and muscle wasting. ESC Heart Fail 2019; 6:894-897. [PMID: 31297975 PMCID: PMC6676286 DOI: 10.1002/ehf2.12487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/17/2019] [Accepted: 06/01/2019] [Indexed: 12/14/2022] Open
Abstract
Takayasu arteritis (TA) is a large vessel vasculitis of unknown aetiology characterized by chronic inflammatory changes of the aorta and its major branches. We report the active TA case who had severe heart failure due to acute myocardial infarction and aortic regurgitation. Bentall procedure was successfully performed, but he had severely depressed left ventricular function and muscle wasting together with vascular inflammation. The treatment with tocilizumab, an interleukin‐6 receptor monoclonal antibody, in addition to prednisolone and standard heart failure therapy led to prompt remission of TA activity and improvement of left ventricular function and muscle wasting. Taken together with possible involvement of interleukin‐6 in the pathogenesis of heart failure and muscle wasting, inhibition of interleukin‐6 receptor signalling by tocilizumab may be a safe and reasonable approach in the treatment of active TA with heart failure and muscle wasting.
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Affiliation(s)
- Toshiyuki Yano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Arata Osanami
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Masaki Shimizu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Satoshi Katano
- Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan
| | - Nobutaka Nagano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Hidemichi Kouzu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Masayuki Koyama
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan.,Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsuko Muranaka
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Ryo Harada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hirosato Doi
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.,Department of Cardiovascular Surgery, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
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30
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Zhang T, Peng B, Tu X, Zhang S, Zhong S, Cao W. Acute myocardial infarction as the first manifestation of Takayasu arteritis: A case report. Medicine (Baltimore) 2019; 98:e15143. [PMID: 30985685 PMCID: PMC6485801 DOI: 10.1097/md.0000000000015143] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Takayasu arteritis (TA) is a chronic inflammatory disease involving the aorta and its major branches. Initial diagnosis is usually difficult due to the highly variable symptoms. Acute myocardial infarction (AMI) is a very rare presentation in patients with TA. Moreover, the choice of early management for these patients is not well established. PATIENT CONCERNS A 34-year-old woman was taken to the Emergency Department of our hospital, presenting with a sudden onset and persistent retrosternal chest pain radiating to both upper extremities for 2 hours. Blood pressures were different between 2 arms with 151/115 mm Hg on the right arm and 140/100 mm Hg on the left arm. DIAGNOSES The patient was diagnosed with TA according to the medical history, physical examination, and vascular imaging. INTERVENTIONS Primary percutaneous coronary intervention (PPCI) was performed to restore the coronary flow of left anterior descending. Meanwhile, combination of oral glucocorticoids and immunosuppressive agents was administered to halt disease progression of TA. OUTCOMES Chest pain was relieved without rest and exertional angina. The patient achieved long-term remission without symptom relapse during our follow-up. LESSONS Percutaneous coronary intervention was essential and effective in AMI of TA. Timely immunosuppressive therapy could improve the long-term outcome.
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Affiliation(s)
- Ting Zhang
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu
- Department of Nursing, Sichuan Vocational College of Health and Rehabilitation, Zigong
| | - Bo Peng
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Xiang Tu
- National Traditional Chinese Medicine Clinical Research Base for Diabetes Mellitus, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine
| | - Shan Zhang
- School of Nursing, Chengdu University of Traditional Chinese Medicine
| | - Sen Zhong
- Hospital Management Committee of Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Wenzhai Cao
- Department of Cardiology, Zigong First People's Hospital, Zigong, Sichuan, PR China
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31
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Bunu DM, Timofte CE, Ciocoiu M, Floria M, Tarniceriu CC, Barboi OB, Tanase DM. Cardiovascular Manifestations of Inflammatory Bowel Disease: Pathogenesis, Diagnosis, and Preventive Strategies. Gastroenterol Res Pract 2019; 2019:3012509. [PMID: 30733802 PMCID: PMC6348818 DOI: 10.1155/2019/3012509] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 11/18/2018] [Accepted: 12/06/2018] [Indexed: 12/16/2022] Open
Abstract
Inflammatory bowel disease (IBD) refers to a group of chronic inflammatory diseases that targets mainly the gastrointestinal tract. The clinical presentation of IBD includes both gastrointestinal manifestations and extraintestinal manifestations (EIM). The reported cardiovascular manifestations in IBD patients include pericarditis, myocarditis, venous and arterial thromboembolism, arrhythmias, atrioventricular block, heart failure, endocarditis, valvulopathies, and Takayasu arteritis. The aim of this article is to review the available literature about the possible pathogenic mechanisms and determine preventive measures capable of reducing the incidence and severity of the cardiovascular manifestations. In IBD patients, the incidence of cardiovascular manifestations is low, but higher than that in the general population. Therefore, clinicians should pay attention to any new modification that might indicate cardiovascular involvement in IBD patients, and they should consider chronic inflammatory diseases in patients with cardiac conditions without an evident cause. Considering the role of inflammation in the development of cardiovascular manifestations, the management should include prevention of flares and maintenance of remission for as long as possible. Preventive measures should also include active screening and strict control of the cardiovascular risk factors in all IBD patients.
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Affiliation(s)
- Diana-Maria Bunu
- Department of Cardiology, Institute of Cardiovascular Diseases, Timisoara 300310, Romania
| | | | - Manuela Ciocoiu
- Department of Pathophysiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Mariana Floria
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
- 3rd Internal Medicine Clinic, “Sf. Spiridon” County Clinical Emergency Hospital Iasi, Iasi, Romania
| | - Claudia-Cristina Tarniceriu
- Department of Morpho-Functional Sciences I, Discipline of Anatomy, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Oana-Bogdana Barboi
- Institute of Gastroenterology and Hepatology-“Sf. Spiridon” County Clinical Emergency Hospital Iasi, Iasi, Romania
- “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Daniela-Maria Tanase
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
- 3rd Internal Medicine Clinic, “Sf. Spiridon” County Clinical Emergency Hospital Iasi, Iasi, Romania
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32
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Large-Vessel Vasculitides. Clin Immunol 2019. [DOI: 10.1016/b978-0-7020-6896-6.00059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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33
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An association study in PTPN22 suggests that is a risk factor to Takayasu's arteritis. Inflamm Res 2018; 68:195-201. [PMID: 30470857 DOI: 10.1007/s00011-018-1204-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Takayasu's arteritis (TA) represents a rare autoimmune disease (AD) characterized by systemic vasculitis that primarily affects large arteries, especially the aorta and the aortic arch and its main branches. Genetic components in TA are largely unknown. PTPN22 is a susceptibility loci for different ADs; however, the role of different PTPN22 single-nucleotide polymorphisms (SNPs) in the susceptibility to TA is not clear. METHODS We evaluated the PTPN22 R620W (C1858T), R263Q (G788A), and - 123G/C SNPs in a group of patients with TA and in healthy individuals from Mexico. Our study included 111 patients with TA and 314 healthy individuals. Genotyping was performed with the 5' exonuclease (TaqMan®) assay. RESULTS Our data showed that the PTPN22 R620W polymorphism is a risk factor for TA (CC vs. CT: OR 4.3, p = 0.002, and C vs. T: OR 4.1, p = 0.003); however, the PTPN22 R263Q and - 1123G/C polymorphisms are not associated with this AD. In addition, the PTPN22 CGT haplotype, which carries the minor allele of the PTPN22 C1858T variant, was also associated with TA susceptibility. CONCLUSION This is the first report documenting an association between PTPN22 R620W and TA.
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34
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Lim RW, Keh YS, Yeo KK, Khanna NN. Takayasu’s arteritis: a review of the literature and the role of endovascular treatment. ASIAINTERVENTION 2018; 4:117-125. [PMID: 36484003 PMCID: PMC9706770 DOI: 10.4244/aij-d-16-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 04/23/2018] [Indexed: 06/17/2023]
Abstract
Takayasu's arteritis (TA) is a chronic non-specific vasculitis with variable presentation in different ethnicities and countries. Treatment options vary and are dependent on the stage and presentation of the disease. We aimed to review current literature related to TA, focusing on the role of endovascular treatment in revascularisation. The temporal course of the disease and stage at presentation influence the management of TA. Treatment options include medical therapy, endovascular intervention or surgical vascular reconstruction. The decision to intervene is individualised according to vascular anatomy and the presence of haemodynamically significant lesions. There are currently no clear guidelines regarding the choice between the endovascular and open surgical approaches, but studies have shown that endovascular procedures are associated with slightly higher rates of restenosis while surgical procedures have higher rates of thrombosis. Periprocedural immunosuppression is suggested if the disease is active at the point of intervention. This improves outcomes but at the cost of immunosuppression-related side effects. Careful long-term follow-up is essential due to the risk of disease activation or flare-up, requiring appropriate evaluation of the diseased vessels.
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Affiliation(s)
| | | | - Khung Keong Yeo
- National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
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Kassa MW, Benti TM, Bedada AG. Successful spinal anaesthesia for caesarean section in an African patient with Takayasu's arteritis. Pan Afr Med J 2018; 30:281. [PMID: 30637066 PMCID: PMC6317383 DOI: 10.11604/pamj.2018.30.281.16182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/06/2018] [Indexed: 11/29/2022] Open
Abstract
Takayasu's arteritis (TA) is a rare chronic inflammatory disease affecting mainly the aorta and its main branches. We report a case of a 24-year-old primigravida, an African patient, with TA planned for caesarean section at 37 weeks of gestation. Clinically, she has involvement of aortic arch and its branches and abdominal aorta. She underwent caesarean section and delivered an alive baby boy under successful spinal anaesthesia with insignificant complications. Although it is rare in the African continent, anesthesiologists should be up-to-date with the knowledge of perioperative anesthetic management of TA in pregnant cases requiring operative delivery.
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Affiliation(s)
- Mamo Woldu Kassa
- Department of Anaesthesia and Critical Care, University of Botswana, Botswana
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Batra K, Chamarthy M, Chate RC, Jordan K, Kay FU. Pulmonary vasculitis: diagnosis and endovascular therapy. Cardiovasc Diagn Ther 2018; 8:297-315. [PMID: 30057877 DOI: 10.21037/cdt.2017.12.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Pulmonary vasculitides are caused by a heterogeneous group of diseases with different clinical features and etiologies. Radiologic manifestations depend on the predominant type of vessel involved, which are grouped into large, medium, or small-sized vessels. Diagnosing pulmonary vasculitides is a challenging task, and radiologists play an important role in their management by providing supportive evidence for diagnosis and opportunities for minimally invasive therapy. This paper aims to present a practical approach for understanding the vasculitides that can affect the pulmonary vessels and lungs. We will describe and illustrate the main radiologic findings, discussing opportunities for minimally invasive treatment.
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Affiliation(s)
- Kiran Batra
- UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Rodrigo Caruso Chate
- Hospital Israelita Albert Einstein and Instituto to Coração HCFMUSP, Sao Paulo, Brazil
| | - Kirk Jordan
- UT Southwestern Medical Center, Dallas, TX, USA
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A Case of Severe Advanced Takayasu Arteritis with Acute Myocardial Infarction as First Manifestation. CURRENT HEALTH SCIENCES JOURNAL 2018; 44:80-84. [PMID: 30622761 PMCID: PMC6295189 DOI: 10.12865/chsj.44.01.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/29/2018] [Indexed: 11/18/2022]
Abstract
We present the case of a 53-year-old female who presented in the emergency room accusing chest pain, dyspnea to moderate physical strain and physical asthenia. The clinical exam highlighted the absence of pulse in the left upper limb, weak pulse at upper right and lower limbs. The angiography revealed severe coronary lesions, bilateral subclavian occlusion, bilateral renal artery occlusion, infrarenal aortic occlusion. The patient was diagnosed with Takayasu's disease. Sequential interventional revascularization was performed. Takayasu arteritis is a rare disease that can easily be overlooked. It can present with severe coronary lesions which require a complex interventional and medical management.
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Abstract
Takayasu arteritis is an idiopathic granulomatous vasculitis of the aorta and its main branches and it constitutes one of the more common vasculitides in children. Inflammation and intimal proliferation lead to wall thickening, stenotic or occlusive lesions, and thrombosis, while destruction of the elastica and muscularis layers originates aneurysms and dissection. Carotid artery tenderness, claudication, ocular disturbances, central nervous system abnormalities, and weakening of pulses are the most frequent clinical features. The diagnosis is usually confirmed by the observation of large vessel wall abnormalities: stenosis, aneurysms, occlusion, and evidence of increased collateral circulation in angiography, MRA or CTA imaging. The purpose of this revision is to address the current knowledge on pathogenesis, investigations, classification, outcome measures and management, and to emphasize the need for timely diagnosis, effective therapeutic intervention, and close monitoring of this severe condition.
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Affiliation(s)
- Ricardo A G Russo
- Service of Immunology & Rheumatology, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - María M Katsicas
- Service of Immunology & Rheumatology, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
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Abstract
Takayasu arteritis (TA) is a rare disease affecting chiefly young women, although it can affect both men and women and persons of many different ethnicities. TA carries a high morbidity rate, but importantly, overall mortality has declined over time such that the 15-year survival rate has increased from 82.9% for patients diagnosed between 1957 and 1975 to 96.5% for those diagnosed from 1976 to 1990. Severity of presenting arterial complications and delay to diagnosis have also decreased over the past decade owing to advances in non-invasive diagnostic imaging and the development of medical therapies. Despite these advances, there still remain significant gaps in the diagnosis and management of these complex patients. These gaps encompass the basic, yet extremely complex, tasks of defining a universally accepted diagnostic criterion, accurate assessment of disease activity and development of clinically meaningful and accurate outcome measures to guide necessary clinical trials for the management of these complex patients.
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Abstract
RATIONALE The initial symptoms and signs of Takayasu arteritis vary due to the heterogeneity of affected vessels. Moreover, the vascular lesions are difficult to detect at initial presentation, making diagnosis even more challenging. Although cases of aortic dissection with arteritis history have been reported, Takayasu arteritis in men with aortic dissection as initial presentation is very rare. PATIENT CONCERNS A 37-year-old man presenting with persistent chest and back pain for 6 days was transferred to our hospital for further treatment. Left hand pulse was absent and right lower limb pulse was feeble. Blood pressure was 144/83 mmHg in the right arm but only 114/62 mmHg in the left arm. DIAGNOSES Computed tomography angiography revealed aortic dissection (DeBakey type III b) from the descending aorta to the distal abdominal aorta. INTERVENTIONS High-dose glucocorticoid therapy and immunosuppressive therapy have been used to control inflammatory reaction during acute period of Takayasu arteritis. Endovascular graft exclusion (EVGE) surgery was performed to cover the primary entry tear and re-expand true lumen during inactive stage. OUTCOMES His pain symptoms improved progressively and he was followed in our outpatient clinic after discharged from hospital, without recurrence. LESSONS Timely therapy (glucocorticoid and immunosuppressive) and corrective surgery (endovascular graft exclusion) for Takayasu arteritis with aortic dissection at the inactive stage is essential and beneficial.
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Affiliation(s)
| | - GuoWu Zhang
- Department of Vascular Surgery, YongChuan Hospital of ChongQing Medical University, ChongQing, China
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Alexanderson-Rosas E, Monroy-Gonzalez AG, Juarez-Orozco LE, Martinez-Aguilar MM, Estrada E, Soldevilla I, Garcia-Pérez O, Soto-Lopez ME. [ 18F]-Sodium fluoride uptake in Takayasu arteritis. J Nucl Cardiol 2017; 24:1674-1679. [PMID: 27506703 DOI: 10.1007/s12350-016-0627-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/08/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND While 18F-fluorodeoxyglucose and 18F-sodium fluoride with positron emission tomography relate with inflammation and calcification, their role in the assessment of patients with Takayasu arteritis has not yet been studied. METHODS We present 5 patients with suspected active metabolic disease who underwent PET with 18F-fluorodeoxyglucose and 18F-sodium fluoride in order to explore the locations and correlations of 18F-fluorodeoxyglucose and 18F-sodium fluoride uptakes. Diagnosis of metabolic active disease was based on 18F-fluorodeoxyglucose uptake. RESULTS We studied 3 female patients and 2 male patients. Median age was 29 years (min: 19 max: 63). In areas with atherosclerotic plaques, we found a negative correlation between 18F-sodium fluoride and 18F-fluorodeoxyglucose uptakes (r = -0.78) (P = .001). Meanwhile, in areas with only metabolic active disease, we found a positive correlation between 18F-sodium fluoride and 18F-fluorodeoxyglucose uptakes (r = 0.94) (P = .019). CONCLUSIONS In Takayasu arteritis, 18F-sodium fluoride uptake can document different stages of metabolic disease, even in the absence of active metabolic disease or symptoms.
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Affiliation(s)
- E Alexanderson-Rosas
- National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico
- PET/CT Unit, National Autonomous University of Mexico, Mexico City, Mexico
| | - A G Monroy-Gonzalez
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Luis Eduardo Juarez-Orozco
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - E Estrada
- National Institute of Cancer, Mexico, Mexico
| | | | | | - M E Soto-Lopez
- National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico.
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Nakajima T, Yoshifuji H, Shimizu M, Kitagori K, Murakami K, Nakashima R, Imura Y, Tanaka M, Ohmura K, Matsuda F, Terao C, Mimori T. A novel susceptibility locus in the IL12B region is associated with the pathophysiology of Takayasu arteritis through IL-12p40 and IL-12p70 production. Arthritis Res Ther 2017; 19:197. [PMID: 28874185 PMCID: PMC5585951 DOI: 10.1186/s13075-017-1408-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/22/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND A previous study revealed the association between susceptibility to Takayasu arteritis (TAK) and a single nucleotide polymorphism (SNP) rs6871626 located in IL12B, which encodes interleukin (IL)-12p40, a common component of IL-12p70 and IL-23. We investigated the expression of these cytokines in patients with TAK, stratifying them into those with or without the risk allele at the rs6871626 SNP. METHODS Plasma levels of IL-12p40, IL-12p70, and IL-23 were quantified in 44 patients with TAK and 19 healthy controls (HCs) by enzyme-linked immunosorbent assays. Monocytes were obtained from 20 patients with TAK and 14 HCs, treated with interferon-γ (IFN-γ) and lipopolysaccharide, and then supernatant cytokines were quantified. In addition, the ratio of IFN-γ+ or IL-17A+ cells to CD4+ T cells was measured by flow cytometric analysis of peripheral blood mononuclear cells. RESULTS The levels of plasma IL-12p40, plasma IL-12p70, and supernatant IL-12p70 were significantly higher in patients with TAK than in HCs, whereas there were no significant differences in the levels of plasma IL-23, supernatant IL-23, or supernatant IL-12p40. The levels of plasma IL-12p70, supernatant IL-12p40, and supernatant IL-12p70 were significantly higher in patients with the risk allele than in those without. The ratio of CD4+IFN-γ+ cells was significantly higher in patients with the risk allele, whereas CD4+IL-17A+ cells showed no differences. CONCLUSIONS The rs6871626 SNP in IL12B may influence the increased expression of IL-12p40 and IL-12p70. These enhanced cytokines might play roles in the pathophysiology of TAK.
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Affiliation(s)
- Toshiki Nakajima
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Masakazu Shimizu
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Kitagori
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kosaku Murakami
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Ran Nakashima
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshitaka Imura
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masao Tanaka
- Department of the Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichiro Ohmura
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Chikashi Terao
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Chen S, Wen X, Li J, Li Y, Li L, Tian X, Yuan H, Zhang F, Li Y. Association of FCGR2A/FCGR3A variant rs2099684 with Takayasu arteritis in the Han Chinese population. Oncotarget 2017; 8:17239-17245. [PMID: 27769046 PMCID: PMC5370036 DOI: 10.18632/oncotarget.12738] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 10/14/2016] [Indexed: 11/25/2022] Open
Abstract
Takayasu arteritis (TA) is a chronic large-vessel vasculitis of unclear pathogenesis. A recent genome-wide association study (GWAS) has revealed that the FCGR2A/FCGR3A, EEFSEC, RPS9/LILRB3, RIPPLY2 and MLX genes confer susceptibility to TA. We investigated the linkage between presumptive TA-related genes (FCGR2A/FCGR3A, EEFSEC, RPS9/LILRB3, RIPPLY2 and MLX) and TA in the Han Chinese population.We performed a large case-control multi-center study of 412 Han Chinese TA patients and 597 ethnically matched healthy controls. Five single nucleotide polymorphisms (SNPs) were assessed and genotyped using Sequenom MassArray system (iPLEX assay, Sequenom, San Diego, CA, USA).The frequency of the rs2099684 variant G allele in the FCGR2A/FCGR3A gene was significantly higher in the TA patients than in the controls (37.5% compared with 25.4%, OR =1.77, 95% CI: 1.46-2.14, Pc =1.5×10-8). Similar results were observed in genotype distribution analysis and logistic regression analyses conducted using three genetic models. The allele and genotype distributions for the other polymorphisms were not significantly associated with TA among the Han Chinese patients.The SNP rs2099684 in FCGR2A/FCGR3A can be considered a genetic risk factor for TA in the Chinese Han population. These findings provide further insights into the etiopathogenesis of TA.
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Affiliation(s)
- Si Chen
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.,Department of Clinical Laboratory, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoting Wen
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jing Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Yuan Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Liubing Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xinping Tian
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Hui Yuan
- Department of Clinical Laboratory, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fengchun Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Yongzhe Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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Empen K, Hummel A, Beug D, Felix SB, Busch MC, Kaczmarek PM. Takayasu's arteritis: a case with relapse after urgent coronary revascularization. BMC Res Notes 2017; 10:311. [PMID: 28854963 PMCID: PMC5576295 DOI: 10.1186/s13104-017-2628-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/13/2017] [Indexed: 11/25/2022] Open
Abstract
Background Vasculitides are commonly unrecognized causes of coronary stenosis and myocardial ischemia. We report on a 24-year old patient with Takayasu’s arteritis who underwent urgent percutaneous coronary intervention, suffered from symptomatic restenosis of the left main coronary artery during standard immunosuppressive therapy. Case presentation A 24-year old woman was referred for coronary angiography because of typical progressive angina pectoris. On bicycle ergometry, there were both reproducible symptoms and deep ST segment depressions on precordial leads. Semi-selective angiography of the left coronary artery revealed high-grade ostial stenosis. Because of persistent angina pectoris and electrocardiographic signs of acute myocardial ischemia, immediate percutaneous coronary angioplasty with subsequent implantation of an everolimus-eluting stent was performed. This intervention was performed with excellent angiographic results. Because of several concomitant criteria including hypoechogenicity on postprocedural intravascular ultrasonography, the diagnosis of Takayasu’s disease was made. The patient was treated with prednisolone and cyclophosphamide for 5 months. Because of recurrent angina pectoris, another coronary angiography was performed, which revealed high-grade in-stent-restenosis. Immunomodulatory therapy was switched to high-dose prednisolone and the anti-IL-6 receptor antagonist tocilizumab. The high-grade in-stent-restenosis persisted, and aortocoronary bypass graft surgery was performed with two saphenous vein grafts to the left anterior descending and circumflex artery. Since then, the patient has been doing well for 2 years. Conclusion In cases of treatment refractoriness during standard immunosuppressive therapy, more recently developed biological compounds may offer an alternative strategy. Electronic supplementary material The online version of this article (doi:10.1186/s13104-017-2628-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Klaus Empen
- Medizinische Klinik B, Universitätsmedizin Greifswald, Sauerbruchstrasse, 17475, Greifswald, Germany.
| | - Astrid Hummel
- Medizinische Klinik B, Universitätsmedizin Greifswald, Sauerbruchstrasse, 17475, Greifswald, Germany
| | - Daniel Beug
- Medizinische Klinik B, Universitätsmedizin Greifswald, Sauerbruchstrasse, 17475, Greifswald, Germany
| | - Stephan B Felix
- Medizinische Klinik B, Universitätsmedizin Greifswald, Sauerbruchstrasse, 17475, Greifswald, Germany
| | - Mathias C Busch
- Medizinische Klinik B, Universitätsmedizin Greifswald, Sauerbruchstrasse, 17475, Greifswald, Germany
| | - Piotr M Kaczmarek
- Medizinische Klinik B, Universitätsmedizin Greifswald, Sauerbruchstrasse, 17475, Greifswald, Germany
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Jeong HS, Jung JH, Song GG, Choi SJ, Hong SJ. Endovascular balloon angioplasty versus stenting in patients with Takayasu arteritis: A meta-analysis. Medicine (Baltimore) 2017; 96:e7558. [PMID: 28723782 PMCID: PMC5521922 DOI: 10.1097/md.0000000000007558] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Symptomatic or significant vascular lesions of Takayasu arteritis (TA) need interventions. Although percutaneous transluminal angioplasty with balloon is a less invasive and safe method, stent implantation in TA can be an alternative option. However, superiority between balloon angioplasty and stenting in TA is not conclusive. METHODS A meta-analysis comparing balloon angioplasty and stenting outcomes was performed using the MEDLINE and EMBASE databases. RESULTS A total of 7 studies on 266 patients and 316 lesions were included. Balloon angioplasty was performed in 186 lesions and stenting in 130 lesions. There were no significant differences in the incidence of both restenosis and other complications between balloon angioplasty and stenting [odds ratio (OR) = 2.39, 95% confidence interval (CI) = 0.66-8.66, P = .18; OR = 1.80, 95% CI = 0.49-6.65, P = .38, respectively]. In the renal arteries, the risk of restenosis in stenting was significantly higher than that in balloon angioplasty (OR = 4.40, 95% CI = 2.14-9.02, P < .001). The clinical efficacy of improving renal hypertension between balloon angioplasty and stenting at the renal artery lesions was similar (OR = 0.65, 95% CI = 0.28-1.51, P = .31); however, acute vascular complications were significantly fewer in stenting than in balloon angioplasty (OR = 0.07, 95% CI = 0.02-0.29, P < .001). CONCLUSION This meta-analysis found that balloon angioplasty can yield better results in renal artery interventions than stenting. Nonetheless, it is desirable to avoid vessel dissections during balloon angioplasty, which can eventually require stent implantations.
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Affiliation(s)
- Han Saem Jeong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital
| | - Jae Hyun Jung
- Division of Rheumatology, Department of Internal Medicine, Korea University Guro Hospital, Seoul
| | - Gwan Gyu Song
- Division of Rheumatology, Department of Internal Medicine, Korea University Guro Hospital, Seoul
| | - Sung Jae Choi
- Division of Rheumatology, Department of Internal Medicine, Korea University Ansan Hospital, Gyeonggi-do, Korea
| | - Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital
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McCallister MB, Fisher KL. Sonographic Evaluation of the Progression of Takayasu’s Arteritis. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2017. [DOI: 10.1177/8756479317699194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Takayasu’s arteritis (TA) is a rare nonspecific inflammatory disease of unknown cause predominantly affecting the aorta and its main branches, coronary arteries, and pulmonary arteries of young females. Diagnosis of TA is typically achieved through computed tomography angiography (CTA) or magnetic resonance angiography (MRA), with sonography often used as a tool for surveillance of disease progression following diagnosis. A case of previously diagnosed TA is presented that demonstrates the effective use of sonography to monitor the progression of the disease with serial examination. The use of CTA and MRA allowed for accurate initial diagnosis, whereas sonography proved to be an effective diagnostic surveillance tool for proper tracking of the disease and its clinical manifestations. Increased sonographer awareness of TA including the clinical manifestations and sonographic characteristics associated with progression of the disease can improve patient outcomes in this potentially life-threatening disease.
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Affiliation(s)
| | - Kelsy L. Fisher
- Diagnostic Medical Ultrasound Program, University of Missouri, Columbia, MO, USA
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Gülcü A, Gezer NS, Akar S, Akkoç N, Önen F, Göktay AY. Long-Term Follow-Up of Endovascular Repair in the Management of Arterial Stenosis Caused by Takayasu's Arteritis. Ann Vasc Surg 2017; 42:93-100. [DOI: 10.1016/j.avsg.2016.10.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/10/2016] [Accepted: 10/22/2016] [Indexed: 11/24/2022]
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Effects of immunosuppressive and biological agents on refractory Takayasu arteritis patients unresponsive to glucocorticoid treatment. J Cardiol 2017; 69:774-778. [DOI: 10.1016/j.jjcc.2016.07.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/01/2016] [Accepted: 07/20/2016] [Indexed: 11/23/2022]
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Akiyama S, Fujii T, Matsuoka K, Yusuke E, Negi M, Takenaka K, Nagahori M, Ohtsuka K, Isobe M, Watanabe M. Endoscopic features and genetic background of inflammatory bowel disease complicated with Takayasu arteritis. J Gastroenterol Hepatol 2017; 32:1011-1017. [PMID: 28449344 DOI: 10.1111/jgh.13640] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/13/2016] [Accepted: 10/29/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Takayasu arteritis (TA) is occasionally complicated with inflammatory bowel disease (IBD). This study assessed the endoscopic and genetic features of IBD complicated with TA (IBD-TA). METHODS This study retrospectively reviewed the clinical charts of 142 TA patients (14 men and 128 women; median age 48.5 years [range, 18-97 years]). Human lymphocyte antigen (HLA) types and a single-nucleotide polymorphism rs6871626 in the IL12B gene were assessed in 101 and 81 patients with TA, respectively. RESULTS Inflammatory bowel disease was diagnosed in 13 (9.2%) of the 142 patients. The endoscopic features of IBD-TA at initial diagnosis (n = 8) showed discontinuous and focal mucosal inflammations (n = 7, 87.5%), and only one case was diagnosed as ulcerative colitis (UC) at the first colonoscopy. In the genetic comparison of HLA class I between TA patients with IBD and those without IBD, HLA-B*52:01 and C*12:02 were more frequent in the IBD-TA group (P = 0.001 and P = 0.009, respectively). Meanwhile, HLA-DRB-1*15:02, DQA-1*01:03, DQB-1*06:01, and DPB-1*09:01 as HLA class II were positively associated with IBD-TA (P = 0.004, P = 0.019, P = 0.019, and P = 0.002, respectively). IL12B rs6871626 did not show an association with IBD-TA compared with that with TA without IBD. CONCLUSIONS The endoscopic findings of IBD-TA at initial diagnosis were atypical for UC or Crohn's disease. IBD-TA possessed the HLA haplotype, which had a susceptible effect on UC.
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Affiliation(s)
- Shintaro Akiyama
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshimitsu Fujii
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Katsuyoshi Matsuoka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ebana Yusuke
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mariko Negi
- Department of Pathology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kento Takenaka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masakazu Nagahori
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuo Ohtsuka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mamoru Watanabe
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
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Yang KQ, Yang YK, Meng X, Zhang Y, Zhang HM, Wu HY, Liu YX, Jiang XJ, Cai J, Zhou XL, Hui RT, Zheng DY, Liu LS. Aortic Dissection in Takayasu Arteritis. Am J Med Sci 2017; 353:342-352. [DOI: 10.1016/j.amjms.2017.01.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/14/2017] [Accepted: 01/19/2017] [Indexed: 11/27/2022]
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