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Yoshifuji H, Nakaoka Y, Uchida HA, Sugihara T, Watanabe Y, Funakoshi S, Isobe M, Harigai M. Organ Damage and Quality of Life in Takayasu Arteritis - Evidence From a National Registry Analysis. Circ J 2024; 88:285-294. [PMID: 38123296 DOI: 10.1253/circj.cj-23-0656] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Takayasu arteritis, affecting primarily young women, damages large arteries and organs. We examined the impact of disease duration and sex on organ damage and quality of life using Japan's Intractable Disease Registry. METHODS AND RESULTS After refining data, 2,013 of 2,795 patients were included in the study. Longer disease duration was related to a lower prevalence of disease activity symptoms, a higher prevalence of organ damage, and a higher proportion of patients requiring nursing care. Compared with men, women tended to have an earlier onset age, exhibiting longer disease duration. A higher proportion of women had aortic regurgitation and required nursing care. The proportion of female patients in employment was lower than that of the general female population, whereas no difference was observed between male patients and the general male population. Logistic regression analysis revealed that age at surveillance, brain ischemia, visual impairment/loss, and ischemic heart disease were significant factors associated with high nursing care needs (Level ≥2, with daily activity limitations). CONCLUSIONS Early diagnosis and effective treatment, particularly to prevent brain ischemia, visual impairment, and ischemic heart disease, may improve the quality of life of patients with Takayasu arteritis, especially women.
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Affiliation(s)
- Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University
| | - Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute
| | - Haruhito A Uchida
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takahiko Sugihara
- Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine
| | | | - Sohei Funakoshi
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University
| | | | - Masayoshi Harigai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine
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2
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Dzhus M, Mostbauer H. Coronary artery lesions in Takayasu arteritis. Reumatologia 2024; 61:460-472. [PMID: 38322104 PMCID: PMC10839913 DOI: 10.5114/reum/176483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/06/2023] [Indexed: 02/08/2024] Open
Abstract
Introduction Takayasu arteritis (TAK) is a granulomatous inflammation of vessels of large diameter, mainly affecting the aorta and its proximal branches, which is more common in young women. The incidence of coronary artery disease in TAK is unknown and not sufficiently studied. Material and methods A literature review was performed for the period 2003 to 2023 using a search of the PubMed and Scopus scientific databases. We used the following key words to search the academic journal databases: "Takayasu arteritis", "coronary angiography", "myocardial revascularization", "coronary artery disease", "angina pectoris", and "myocardial infarction". Results The analysis of studies showed that coronary artery lesions (CAL) in TAK are not uncommon, being identified particularly in children and young individuals. Pathology of the coronary arteries increases the morbidity and mortality of TAK patients. In TAK, the ostia and proximal segments of the coronary arteries are more frequently affected, presenting as stenosis or occlusion with the development of stable coronary artery disease, unstable coronary artery disease, acute myocardial infarction, and sudden death. The diagnosis of TAK and coronary artery pathology is often complicated due to nonspecific manifestations and frequently the absence of symptoms. The treatment of patients with TAK with CAL is challenging and requires both pharmacological therapy and interventional or surgical methods of myocardial revascularization. Conclusions Takayasu arteritis is a more prevalent cause of CAL development, especially in young patients, than previously believed, and cardiovascular death due to CAL is not rare. Early diagnosis of TAK with CAL, particularly occlusion or hemodynamically significant stenosis, and the prompt initiation of appropriate treatment prevent dangerous complications, reduce mortality, and improve prognosis.
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Affiliation(s)
- Marta Dzhus
- Department of Internal Medicine No. 2, O. Bohomolets National Medical University, Kyiv, Ukraine
| | - Halyna Mostbauer
- Department of Internal Medicine No. 2, O. Bohomolets National Medical University, Kyiv, Ukraine
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3
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Abstract
Multimodality cardiovascular imaging is an essential component of the clinical management of patients with large-vessel vasculitis (LVV), a chronic, relapsing and remitting inflammatory disease of the aorta and its major branches. Imaging is needed to confirm the initial diagnosis, to survey the extent and severity of arterial involvement, to screen for cardiovascular complications and for subsequent long-term disease monitoring. Indeed, diagnosing LVV can be challenging due to the non-specific nature of the presenting symptoms, which often evoke a broad differential. Identification of disease flares and persistent residual arteritis following conventional treatments for LVV present additional clinical challenges. However, by identifying and tracking arterial inflammation and injury, multimodality imaging can help direct the use of disease-modifying treatments that suppress inflammation and prevent or slow disease progression. Each of the non-invasive imaging modalities can provide unique and complementary information, contributing to different aspects of the overall clinical assessment. This article provides a focused review of the many roles of multimodality imaging in LVV.
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Affiliation(s)
- Jason M Tarkin
- Section of Cardiorespiratory Medicine, University of Cambridge, Heart & Lung Research Institute, Cambridge, UK
| | - Deepa Gopalan
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
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Suryono S, Wulandari P, Ariyanti D, Maulana AS, Sembodo RH, Junior NW, Saputra AD. Takayasu arteritis with congestive heart failure in 26-year-old male: a case report. Egypt Heart J 2022; 74:41. [PMID: 35596814 PMCID: PMC9124251 DOI: 10.1186/s43044-022-00279-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Takayasu arteritis (TA) is included in large vessel vasculitis with unknown aetiopathogenesis. TA is one of the rare diseases with a predilection for young women. The diagnosis of TA is difficult due to variation in clinical presentations and non-specific initial symptoms. This case demonstrates rare TA in a young male with congestive heart failure as the predominant manifestation. CASE PRESENTATION We report a 26-year-old male presented with severe dyspnea, palpitation, orthopnea, paroxysmal nocturnal dyspnea, and claudication in the left arm. Four limbs blood pressure discrepancy was present. Chest X-ray showed cardiomegaly with calcification aortic arch and pulmonary edema. Echocardiography revealed that left ventricular ejection fraction decreased with severe aortic and mitral valve regurgitation. Computed tomography angiography showed stenosis of the left common carotid artery and total occlusion of the left subclavian artery with collateral artery. There was vascular thickness and calcification from the peri-aortic valve, ascending aorta, aortic arch, and thoracic descending aorta until abdominal aorta with high-grade stenosis on the inferior side of the renal artery branching accompanied by a post-stenotic dilatation. CONCLUSIONS This patient's heart failure was precipitated by secondary hypertension and aortic regurgitation caused by vasculitis of TA. In general, there is no difference in the management of congestive heart failure in patients with TA. Optimized pharmacology therapy with combination steroid and methotrexate successfully inducing remission of TA after 3-months follow-up.
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Affiliation(s)
- Suryono Suryono
- Departement of Cardiology, Faculty of Medicine, University of Jember - Dr. Soebandi General Hospital, Jl. Kalimantan No. 37, Jember, East Java, 68121, Indonesia.
| | - Pipiet Wulandari
- Departement of Cardiology, Faculty of Medicine, University of Jember - Dr. Soebandi General Hospital, Jl. Kalimantan No. 37, Jember, East Java, 68121, Indonesia
| | - Dwi Ariyanti
- Departement of Cardiology, Faculty of Medicine, University of Jember - Dr. Soebandi General Hospital, Jl. Kalimantan No. 37, Jember, East Java, 68121, Indonesia
| | - Aditha Satria Maulana
- Departement of Cardiology, Faculty of Medicine, University of Jember - Dr. Soebandi General Hospital, Jl. Kalimantan No. 37, Jember, East Java, 68121, Indonesia
| | - R Handi Sembodo
- Departement of Radiology, Faculty of Medicine, University of Jember - Dr. Soebandi General Hospital, Jl. Kalimantan No. 37, Jember, East Java, 68121, Indonesia
| | - Narendra Wahyu Junior
- Departement of Radiology, Faculty of Medicine, University of Jember - Dr. Soebandi General Hospital, Jl. Kalimantan No. 37, Jember, East Java, 68121, Indonesia
| | - Antonius Dwi Saputra
- Faculty of Medicine, University of Jember, Jl. Kalimantan No. 37, Jember, East Java, 68121, Indonesia
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5
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Aeschlimann FA, Raimondi F, Leiner T, Aquaro GD, Saadoun D, Grotenhuis HB. Overview of imaging in adult- and childhood-onset Takayasu arteritis. J Rheumatol 2021; 49:346-357. [PMID: 34853087 DOI: 10.3899/jrheum.210368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 11/22/2022]
Abstract
Takayasu Arteritis is an idiopathic large vessel vasculitis, that affects young adults and children and can lead to ischemia and end-organ damage. Vascular imaging is crucial for diagnosis, assessment of disease extent and management of the disease. In this article, we critically review evidence for the clinical use of the different imaging modalities conventional angiography, magnetic resonance imaging, computed tomography, Doppler ultrasound and 18fluorodeoxyglucose positron emission tomography. We thereby focus on their clinical applicability, challenges and specific use in children.
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Affiliation(s)
- Florence A Aeschlimann
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
| | - Francesca Raimondi
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
| | - Tim Leiner
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
| | - Giovanni Donato Aquaro
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
| | - David Saadoun
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
| | - Heynric B Grotenhuis
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France and Division of Pediatrics, Kantonsspital Winterthur, Winterthur, Switzerland; Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker Enfants-Malades, Paris, France; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Division of Pediatric Cardiology, Department of Pediatrics, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. Conflicts of interest. The authors declare no conflicts of interest. Address correspondence to Florence A Aeschlimann, MD MPH, Pediatric Immunology, Hematology and Rheumatology Unit, 149, Rue de Sèvres, F - 75743 Paris, France. E-mail:
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6
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Wall C, Huang Y, Le EPV, Ćorović A, Uy CP, Gopalan D, Ma C, Manavaki R, Fryer TD, Aloj L, Graves MJ, Tombetti E, Ariff B, Bambrough P, Hoole SP, Rusk RA, Jayne DR, Dweck MR, Newby D, Fayad ZA, Bennett MR, Peters JE, Slomka P, Dey D, Mason JC, Rudd JHF, Tarkin JM. Pericoronary and periaortic adipose tissue density are associated with inflammatory disease activity in Takayasu arteritis and atherosclerosis. EUROPEAN HEART JOURNAL OPEN 2021; 1:oeab019. [PMID: 34661196 PMCID: PMC8508012 DOI: 10.1093/ehjopen/oeab019] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 12/20/2022]
Abstract
AIMS To examine pericoronary adipose tissue (PCAT) and periaortic adipose tissue (PAAT) density on coronary computed tomography angiography for assessing arterial inflammation in Takayasu arteritis (TAK) and atherosclerosis. METHODS AND RESULTS PCAT and PAAT density was measured in coronary (n = 1016) and aortic (n = 108) segments from 108 subjects [TAK + coronary artery disease (CAD), n = 36; TAK, n = 18; atherosclerotic CAD, n = 32; matched controls, n = 22]. Median PCAT and PAAT densities varied between groups (mPCAT: P < 0.0001; PAAT: P = 0.0002). PCAT density was 7.01 ± standard error of the mean (SEM) 1.78 Hounsfield Unit (HU) higher in coronary segments from TAK + CAD patients than stable CAD patients (P = 0.0002), and 8.20 ± SEM 2.04 HU higher in TAK patients without CAD than controls (P = 0.0001). mPCAT density was correlated with Indian Takayasu Clinical Activity Score (r = 0.43, P = 0.001) and C-reactive protein (r = 0.41, P < 0.0001) and was higher in active vs. inactive TAK (P = 0.002). mPCAT density above -74 HU had 100% sensitivity and 95% specificity for differentiating active TAK from controls [area under the curve = 0.99 (95% confidence interval 0.97-1)]. The association of PCAT density and coronary arterial inflammation measured by 68Ga-DOTATATE positron emission tomography (PET) equated to an increase of 2.44 ± SEM 0.77 HU in PCAT density for each unit increase in 68Ga-DOTATATE maximum tissue-to-blood ratio (P = 0.002). These findings remained in multivariable sensitivity analyses adjusted for potential confounders. CONCLUSIONS PCAT and PAAT density are higher in TAK than atherosclerotic CAD or controls and are associated with clinical, biochemical, and PET markers of inflammation. Owing to excellent diagnostic accuracy, PCAT density could be useful as a clinical adjunct for assessing disease activity in TAK.
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Affiliation(s)
- Christopher Wall
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Yuan Huang
- EPSRC Centre for Mathematical Imaging in Healthcare, University of Cambridge, Cambridge, UK
| | - Elizabeth P V Le
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Andrej Ćorović
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Christopher P Uy
- Vascular Sciences, National Heart & Lung Institute, Faculty of Medicine, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 0HS, UK
| | - Deepa Gopalan
- Department of Radiology, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 2QQ, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, W12 0HS, UK
| | - Chuoxin Ma
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Roido Manavaki
- Department of Radiology, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Tim D Fryer
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Luigi Aloj
- Department of Radiology, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Martin J Graves
- Department of Radiology, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Enrico Tombetti
- Department of biomedical Sciences L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Ben Ariff
- Department of Radiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, W12 0HS, UK
| | - Paul Bambrough
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK CB2 0AY, UK
| | - Stephen P Hoole
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK CB2 0AY, UK
| | - Rosemary A Rusk
- Department of Cardiology, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 2QQ, UK
| | - David R Jayne
- Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - David Newby
- Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Zahi A Fayad
- BioMedical Engineering & Imaging Institute, Icahn School of Medicine at Mt Sinai, Gustave L. Levy Place, New York, NY 10029-5674, USA
| | - Martin R Bennett
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - James E Peters
- Centre for Inflammatory Diseases, Imperial College London, London, UK
| | - Piotr Slomka
- Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Los Angeles, CA, 90048, USA
| | - Justin C Mason
- Vascular Sciences, National Heart & Lung Institute, Faculty of Medicine, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 0HS, UK
| | - James H F Rudd
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Jason M Tarkin
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
- Vascular Sciences, National Heart & Lung Institute, Faculty of Medicine, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 0HS, UK
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7
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Abstract
A young pregnant woman, G2P1L1, was admitted for safe confinement at 40 weeks of gestation with Takayasu arteritis. She was diagnosed with Takayasu arteritis in 2016 when she had polyarthritis, hypertension and asymmetrical peripheral pulses. Her CT angiogram showed involvement of branches of aortic arch and coeliac trunk. She had mild pulmonary hypertension and was classified as type V disease (P)+. She was started on immunosuppressant medication and achieved a fair control of symptoms and disease activity. She gave history of treatment for pulmonary tuberculosis for 6 months in 2016 after which she developed polyarthralgia. She is currently asymptomatic and had mild hypertension that was controlled. She was evaluated for evidence of aneurysms/thrombus/aortic insufficiency and taken up for elective caesarean in view of type V disease. Maternal and perinatal outcome was good and she was discharged on her regular medication as per immunology opinion.
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Affiliation(s)
- Papa Dasari
- Obstetrics and Gynaecology, JIPMER, Puducherry, Tamil Nadu, India
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8
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Zhou Y, Feng Y, Zhang W, Li H, Zhang K, Wu Z. Physical Exercise in Managing Takayasu Arteritis Patients Complicated With Cardiovascular Diseases. Front Cardiovasc Med 2021; 8:603354. [PMID: 34055922 PMCID: PMC8149735 DOI: 10.3389/fcvm.2021.603354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 03/29/2021] [Indexed: 12/12/2022] Open
Abstract
Takayasu arteritis (TA) is a kind of large-vessel vasculitis that mainly affects the aorta and its branches, and the patients are usually women at a relatively young age. The chronic inflammation of arteries in TA patients leads to stenosis, occlusion, dilatation, or aneurysm formation. Patients with TA thereby have a high risk of cardiovascular disease (CVD) complications, which are the most common cause of mortality. This review summarizes the main cardiovascular complications and the risk factors of cardiovascular complications in patients with TA. Here, we discuss the benefits and potential risks of physical exercise in patients with TA and give recommendations about exercise prescription for TA patients to decrease the risks of CVD and facilitate rehabilitation of cardiovascular complications, which might maximally improve the outcomes.
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Affiliation(s)
- Yaxin Zhou
- Department of Clinical Immunology, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Yuan Feng
- Department of Rheumatology and Immunology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Wei Zhang
- Department of Rheumatology and Immunology, Xi'an No.5 Hospital, Xi'an, China
| | - Hongxia Li
- Department of Clinical Immunology, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China.,Department of Rheumatology and Immunology, Air Force Medical Center, Air Force Medical University (Fourth Military Medical University), Beijing, China
| | - Kui Zhang
- Department of Clinical Immunology, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Zhenbiao Wu
- Department of Clinical Immunology, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China
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9
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Khanna S, Garikapati K, Goh DSL, Cho K, Lo P, Bhojaraja MV, Tarafdar S. Coronary artery vasculitis: a review of current literature. BMC Cardiovasc Disord 2021; 21:7. [PMID: 33407141 PMCID: PMC7788693 DOI: 10.1186/s12872-020-01813-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022] Open
Abstract
Cardiac vasculitis is recognized as a heterogeneous disease process with a wide spectrum of manifestations including pericarditis, myocarditis, valvular heart disease and less frequently, coronary artery vasculitis (CAV). CAV encompasses an emerging field of diseases which differ from conventional atherosclerotic disease and have a proclivity for the younger population groups. CAV portends multiple complications including the development of coronary artery aneurysms, coronary stenotic lesions, and thrombosis, all which may result in acute coronary syndromes. There are several aetiologies for CAV; with Kawasaki's disease, Takayasu's arteritis, Polyarteritis Nodosa, and Giant-Cell Arteritis more frequently described clinically, and in literature. There is a growing role for multi-modality imaging in assisting the diagnostic process; including transthoracic echocardiography, cardiac magnetic resonance imaging, computed tomography coronary angiography, fluorodeoxyglucose-positron emission tomography and conventional coronary angiogram with intravascular ultrasound. Whilst the treatment paradigms fundamentally vary between different aetiologies, there are overlaps with pharmacological regimes in immunosuppressive agents and anti-platelet therapies. Interventional and surgical management are is a consideration in select populations groups, within a multi-disciplinary context. Further large-scale studies are required to better appropriately outline management protocols in this niche population.
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Affiliation(s)
- Shaun Khanna
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia.
| | - Kartheek Garikapati
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | - Daniel S L Goh
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | - Kenneth Cho
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | - Phillip Lo
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | | | - Surjit Tarafdar
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia.,Faculty of Medicine, Western Sydney University, Sydney, NSW, Australia
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Koster MJ, Warrington KJ, Matteson EL. Morbidity and Mortality of Large-Vessel Vasculitides. Curr Rheumatol Rep 2020; 22:86. [DOI: 10.1007/s11926-020-00963-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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11
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The relationships of serum homocysteine levels and traditional lipid indicators with disease activity and coronary artery involvement in Takayasu arteritis. Immunol Res 2020; 68:405-413. [PMID: 33064263 DOI: 10.1007/s12026-020-09157-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/01/2020] [Indexed: 12/14/2022]
Abstract
Serum homocysteine (HCY) levels have been associated with the occurrence of coronary stenosis and disease activity in large-vessel vasculitis. However, whether increases in serum HCY levels and traditional lipid indicators are associated with coronary artery involvement and disease activity in Chinese Han Takayasu arteritis (TA) patients is unknown. This study aims to investigate the clinical and laboratory features of TA by assessing their association with disease activity in TA patients, and to explore the risk factors associated with coronary artery involvement in these patients. Serum HCY levels and traditional lipid indicators were tested in one hundred ninety TA patients and one hundred fifty-four healthy controls. We analyzed the relationships of serum HCY levels and traditional lipid indicators with disease activity and analyzed the risk factors for coronary artery involvement. Twenty-one TA patients were found to have coronary artery stenosis (≥ 50%). TA patients had significantly higher levels of HCY than did healthy controls (p < 0.0001). Serum levels of HCY and low-density lipoprotein cholesterol (LDL-C); the ratios of LDL-C to high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC) to HDL-C, and triglycerides (TG) to HDL-C; and the values of atherogenic index of plasma (AIP) were significantly higher in patients with active TA than in patients with inactive TA and in TA patients with coronary artery involvement than in TA patients without coronary artery involvement. By contrast, the serum levels of HDL-C were significantly lower in patients with active TA than in patients with inactive TA and in TA patients with coronary artery involvement than in TA patients without coronary artery involvement (p < 0.05). In addition, the serum levels of TC and TG were significantly higher in TA patients with coronary artery involvement than those in TA patients without coronary artery involvement. Elevated serum HCY levels increased the risk of coronary artery involvement by 1.3-fold (p = 0.011, odds ratio [OR] = 1.275, 95% confidence interval [CI]: 1.056-1.539), and the cutoff value for serum HCY was 9.55 μmol/L. Elevated serum TG levels increased the risk of coronary artery involvement by 3.5-fold (p < 0.0001, OR = 3.534, 95% CI: 1.907-6.547), and the cutoff value for serum TG was 1.215 mmol/L. The risk of coronary artery involvement was 2.5-fold higher when an elevated TG/HDL-C ratio was present (p < 0.0001, OR = 2.513, 95% CI: 1.567-4.032). This study showed that serum HCY and TG levels and the TG/HDL-C ratio are independent risk factors for coronary artery involvement in TA patients.
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12
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Wang Y, Jia SJ, Zhou Y, Li J, Zhao X, Zhao QM, Yang GL. A study on the risk factors of coronary artery disease in patients with Takayasu arteritis. J Thorac Dis 2020; 12:2031-2038. [PMID: 32642105 PMCID: PMC7330393 DOI: 10.21037/jtd-20-267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background The aim of this study was to investigate the risk factors of Takayasu arteritis (TA) involving the coronary artery. Methods Patients with TA involving coronary artery were included in this study. According to the patients’ condition of coronary artery involvement, they were divided into two groups: group A: TA involved coronary artery disease [at least one coronary artery stenosis (≥50%)] and group B: TA did not involve coronary artery. A logistic regression model was used to analyze the risk factors of arteritis involving the patients’ coronary artery lesions. Results A total of 442 TA patients were included in this study. The patients were significantly older in group A than those patients in group B (52.54±11.17 vs. 37.73±12.72, P<0.001). The age of onset in group A was significantly older than those patients in group B (42.21±11.46 vs. 32.74±13.13, P<0.001). The patients in group A had a longer course of disease (P<0.001), larger BMI (P=0.002) and higher rates of smoking, drinking, diabetes, dyslipidemia (P<0.05) when compared with group B. The level of eGFR was significantly decreased and the UA and TG levels were significantly increased in group A when compared with group B(P<0.05). Besides, the risk factors for TA involving coronary artery included the age of TA onset (OR =1.143, 95% CI: 1.007–1.298, P=0.039), course of TA (OR =1.165, 95% CI: 1.025–1.324, P=0.020), and BMI (OR =1.100, 95% CI: 1.021–1.185, P=0.013). Conclusions The later the age of TA onset, the longer the course of TA onset and the more traditional risk factors associated with atherosclerosis, the more vulnerable patients are to coronary artery involvement and this may not be related to clinical disease activity.
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Affiliation(s)
- Yang Wang
- Department of Special medical, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Shu-Jie Jia
- Department of Special medical, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yun Zhou
- Department of Special medical, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jing Li
- Department of Special medical, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Xin Zhao
- Department of Special medical, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Quan-Ming Zhao
- Department of Special medical, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Guan-Lin Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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13
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Numano type V Takayasu arteritis patients are more prone to have coronary artery involvement. Clin Rheumatol 2020; 39:3439-3447. [DOI: 10.1007/s10067-020-05123-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
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Pan L, Du J, Liu J, Liao H, Liu X, Guo X, Liang J, Han H, Yang L, Zhou Y. Tocilizumab treatment effectively improves coronary artery involvement in patients with Takayasu arteritis. Clin Rheumatol 2020; 39:2369-2378. [PMID: 32144625 DOI: 10.1007/s10067-020-05005-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 01/21/2020] [Accepted: 02/20/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Coronary artery involvement in Takayasu arteritis (TAK) leads to poor prognosis and high mortality. Tocilizumab (TCZ) has been used to effectively treat large vessel vasculitis. However, the efficacy of TCZ in resolving coronary artery involvement in TAK is unclear. The aim of this retrospective study was to evaluate the efficacy of TCZ in the treatment of coronary artery involvement in TAK. METHODS Clinical features and manifestations of coronary artery lesions in 11 TAK patients were evaluated before and after TCZ treatment, and the results were compared with those of 11 patients treated with traditional disease-modifying antirheumatic drugs (DMARDs). RESULTS C-reactive protein (p = 0.006), erythrocyte sedimentation rate (ESR) (p = 0.011), and Kerr score (p = 0.007) were significantly decreased post-TCZ treatment for 6 months. The Indian Takayasu Clinical Activity Score (ITAS) 2010 (p = 0.019) and ITAS-A (p = 0.019) were significantly lower in patients treated with TCZ compared with those treated with traditional DMARDs. The glucocorticoid (GC) dose was tapered to 2.50 (0.00, 7.50) mg day-1 after TCZ treatment for 6 months, which was significantly lower than the GC dose after traditional DMARDs treatment [10.0 (5.00, 11.25) mg.day-1, (p = 0.033)]. After 6-month TCZ treatment, the total number of coronary artery lesions was reduced from 23 to 15 in 6 patients. Vascular wall thickening was remarkably improved in 2 lesions (in the ostia of the left main and right coronary arteries). CONCLUSION TCZ may decrease the disease activity and improve coronary artery lesion in patients with TAK. Key Points • TCZ treatment significantly decreased the disease activity in TAK patients with coronary artery involvement. • TCZ treatment significantly reduces the dosage of GC. • TCZ treatment led to an improvement in imaging findings of TAK patients with coronary artery involvement.
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Affiliation(s)
- Lili Pan
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Juan Du
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiayi Liu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hua Liao
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoli Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Xi Guo
- Department of Interventional Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jing Liang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Hongya Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Lixia Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China.
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Aeschlimann FA, Twilt M, Yeung RSM. Childhood-onset Takayasu Arteritis. Eur J Rheumatol 2020; 7:S58-S66. [PMID: 35929861 PMCID: PMC7004266 DOI: 10.5152/eurjrheum.2019.19195] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/04/2019] [Indexed: 09/02/2023] Open
Abstract
Childhood-onset Takayasu Arteritis (cTAK) is a rare, large-vessel type of vasculitis seen in children, mainly affecting the aorta and its major branches. Clinical manifestations are often severe and arise as a result of systemic and local inflammation, along with end-organ ischemia. Disease flares are common and the disease burden is high, with a significant rate of morbidity and mortality. Recent advances in understanding the underlying disease pathobiology resulted in the use of pathway-targeting agents, such as TNF- or IL-6 inhibitors with improved disease control. Nonetheless, the prognosis often remains guarded and the accrued damage is significant. This review aims at summarizing the recent evidence and observations regarding this condition, with a focus on pediatric publications.
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Affiliation(s)
- Florence A Aeschlimann
- Paediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France; Division of Paediatrics, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Marinka Twilt
- Division of Rheumatology, Department of Paediatric, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Alberta, Canada; Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rae S M Yeung
- Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Immunology, University of Toronto, Toronto, Ontario, Canada
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Increased Arterial Stiffness Adversely Affects Left Ventricular Mechanics in Patients With Pediatric Takayasu Arteritis From a Toronto Cohort. J Clin Rheumatol 2019; 25:171-175. [PMID: 29782425 DOI: 10.1097/rhu.0000000000000824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE Takayasu arteritis (TA) is characterized by extensive aortic, large and midsize arterial wall inflammation. The aim of this study was to assess the morphological and elastic properties of the aorta and large arteries and the impact on left ventricular (LV) mechanics in children with TA. METHODS Seven pediatric TA patients (6 female patients, 13.8 ± 3.2 years) were assessed with magnetic resonance imaging, vascular ultrasound, applanation tonometry, and echocardiography from February 2015 until July 2017 and compared with 7 age- and sex-matched controls. Takayasu arteritis disease activity was assessed clinically by the Pediatric Vasculitis Activity Score (PVAS). RESULTS Pediatric TA patients showed increased carotid-to-radial artery pulse wave velocity (8.1 ± 1.8 vs. 6.4 ± 0.6 m/s, p = 0.03) and increased carotid-to-femoral artery pulse wave velocity (8.3 ± 1.9 vs. 5.1 ± 0.8 m/s, p < 0.01) when compared with controls. Patients demonstrated increased LV mass index (74.3 ± 18.8 vs. 56.3 ± 10.9 g/m, p = 0.04), altered myocardial deformation with increased basal rotation (-9.8 ± 4.5 vs. -4.0 ± 2.0 degrees, p = 0.01) and torsion (19.9 ± 8.1 vs. 9.1 ± 3.1 degrees, p = 0.01), and impaired LV diastolic function with decreased mitral valve E/A ratio (1.45 ± 0.17 vs. 2.40 ± 0.84, p = 0.01), increased mitral valve E/E' ratio (6.8 ± 1.4 vs. 4.9 ± 0.7, p < 0.01), and increased pulmonary vein A-wave velocity (26.7 ± 5.7 vs. 16.8 ± 3.3 cm/s, p = 0.03). Carotid-to-radial artery pulse wave velocity was associated with systolic (R = 0.94, p < 0.01), diastolic (R = 0.85, p = 0.02), and mean blood pressure (R = 0.91, p < 0.01), as well as disease activity by PVAS (R = 0.75, p = 0.05). The PVAS was associated with carotid-to-radial artery pulse wave velocity (R = 0.75, p = 0.05), as well as systolic (R = 0.84, p = 0.02), diastolic (R = 0.82, p = 0.03), and mean blood pressure (R = 0.84, p = 0.02). CONCLUSIONS Increased arterial stiffness is present in pediatric TA patients and associated with increased blood pressure and TA disease activity. Pediatric TA patients demonstrate altered LV mechanics, LV hypertrophy, and impaired diastolic function.
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Protocol using wide-detector CT with single contrast injection for the aorta and coronary artery: variable helical pitch versus volume scan following helical scan. Int J Cardiovasc Imaging 2019; 35:1935-1942. [DOI: 10.1007/s10554-019-01640-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
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Surgical intervention and its role in Takayasu arteritis. Best Pract Res Clin Rheumatol 2018; 32:112-124. [PMID: 30526891 DOI: 10.1016/j.berh.2018.07.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 06/27/2018] [Accepted: 07/06/2018] [Indexed: 12/13/2022]
Abstract
Vascular surgery remains an important option in the management of Takayasu arteritis (TA). Its use is predominantly confined to the treatment of symptomatic organ ischaemia or life-threatening aneurysm formation. In most cases, this follows the failure of medical therapy to prevent arterial injury. Open surgery and endovascular approaches are used. The choice between them, at least in part, is determined by the site and nature of the lesion. Open surgery, although more invasive, offers enhanced duration of arterial patency, whereas for endovascular intervention, primary angioplasty without stenting is preferred, with stenting reserved for primary or secondary angioplasty failures. Although there is increasing interest in the role of stent grafts and tailor-made endovascular stents, long-term outcomes remain to be reported. Interventional outcomes are improved and complications reduced by therapeutic control of disease activity before and after surgery. The wider use of combined immunosuppression and the introduction of biologic therapy for refractory TA may reduce future requirements for surgical intervention.
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19
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Sun Y, Huang Q, Jiang L. Radiology and biomarkers in assessing disease activity in Takayasu arteritis. Int J Rheum Dis 2018; 22 Suppl 1:53-59. [PMID: 29624875 DOI: 10.1111/1756-185x.13286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Ying Sun
- Department of Rheumatology; Zhongshan Hospital; Fudan University; Shanghai China
| | - Qingrong Huang
- Department of Rheumatology; Zhongshan Hospital; Fudan University; Shanghai China
| | - Lindi Jiang
- Department of Rheumatology; Zhongshan Hospital; Fudan University; Shanghai China
- Center of Evidence-based Medicine; Fudan University; Shanghai China
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21
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Tombetti E, Mason JC. Application of imaging techniques for Takayasu arteritis. Presse Med 2017; 46:e215-e223. [PMID: 28757178 DOI: 10.1016/j.lpm.2017.03.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 03/07/2017] [Indexed: 11/26/2022] Open
Abstract
Arterial injury with subsequent remodelling and predisposition to arterial stenosis and/or dilation are the hallmarks of Takayasu arteritis. The degree of arterial damage closely aligns with prognosis and therefore its prevention is the predominant aim of therapy. Non-invasive imaging has greatly improved our ability to identify the extent and severity of disease and to monitor its progress. However, many questions remain concerning the optimal use of individual modalities at different stages of disease. Imaging methods for the quantification of arterial damage are lacking. Likewise, no single technique can accurately determine disease activity within the arterial wall or distinguish inflammatory and non-inflammatory disease progression. The aim of this review is to outline current imaging strategies in Takayasu arteritis, their individual roles in diagnosis and disease monitoring and potential future advances.
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Affiliation(s)
- Enrico Tombetti
- San Raffaele Scientific Institute, Department of Immunology, Transplantation and Infectious Diseases, Milano, Italy.
| | - Justin C Mason
- Hammersmith Hospital, Imperial College London, Rheumatology and Vascular Science, London, UK
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Yang Y, Tian T, Yang K, Zhang Y, Meng X, Fan P, Feng L, Mu C, Gao L, Zhou X. Outcomes of percutaneous coronary intervention and coronary artery bypass grafting in patients with Takayasu arteritis. Int J Cardiol 2017; 241:64-69. [PMID: 28237733 DOI: 10.1016/j.ijcard.2017.02.041] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/10/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Coronary artery involvement is not a rare presentation of Takayasu arteritis (TA) and the treatment is challenging. The optimal methods of revascularization, and prognosis of treatment have not been established. OBJECTIVES To assess the long-term outcomes of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in TA patients. METHODS Patients with coronary artery involved in TA who underwent either PCI or CABG were identified between February 2003 and December 2015. The primary outcome was long-term all-cause mortality. Secondary outcomes were myocardial infarction (MI), stroke, and repeat revascularization. RESULTS Thirty-one patients were enrolled (PCI=19 vs. CABG=12). Most of them were female (25, 80.6%) and the mean age was 42.6±13.8years (16-64years). Angina pectoris was the most common initial symptom (26 cases, 83.9%) and concomitant aortic regurgitation was present in 8 (25.8%) patients. Both groups had a low rate of corticosteroids use [4/19 (21.1%) vs. 2/12 (16.7%)]. During the median follow-up of 101months (10-384months), PCI group had a significantly higher incidence of restenosis [12/19(63.2%) vs. 3/12(25%)]. Two patients with severe aortic regurgitation in PCI group suffered from cardiac death during follow-up. CONCLUSIONS Coronary artery involvement should be suspected in TA patients with angina pectoris, especially young women. PCI had a very high rate of in-stent restenosis in patients without corticosteroids and CABG may be a preferred treatment option.
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Affiliation(s)
- Yankun Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Tao Tian
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Kunqi Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ying Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xu Meng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Peng Fan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Lei Feng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Chaowei Mu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Linggen Gao
- Department of Geriatric Cardiology, General Hospital of Chinese People's Liberation Army, Beijing 100853, China
| | - Xianliang Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
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Dehaene A, Jacquier A, Falque C, Gorincour G, Gaubert JY. Imaging of acquired coronary diseases: From children to adults. Diagn Interv Imaging 2016; 97:571-80. [PMID: 27130480 DOI: 10.1016/j.diii.2016.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 02/09/2023]
Abstract
Acquired coronary diseases include aneurysms, fistulae, dissections, and stenosis. Aneurysms may occur secondarily to Kawasaki disease, a childhood vasculitis, the prognosis of which depends on the coronary involvement, or they may be degenerative, infectious, inflammatory, or traumatic in origin. Fistulae develop between the coronary arterial system and a pulmonary or bronchial artery, or cardiac cavity. Dissections may occur spontaneously or may be post-traumatic. These coronary abnormalities may be found incidentally or may present as complications, infarction or rupture. The goals of this article are to understand acquired childhood and adult coronary diseases and their usual means of presentation, the ways of investigating them, and the principles of their treatment.
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Affiliation(s)
- A Dehaene
- Department of adult radiology, La Timone Hospital, AP-HM, Marseille, France.
| | - A Jacquier
- Department of adult radiology, La Timone Hospital, AP-HM, Marseille, France
| | - C Falque
- Department of adult radiology, La Timone Hospital, AP-HM, Marseille, France
| | - G Gorincour
- Department of pediatric radiology, La Timone Hospital, AP-HM, Marseille, France
| | - J Y Gaubert
- Department of adult radiology, La Timone Hospital, AP-HM, Marseille, France
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Kandoria A, Kandoria M, Ganju N, Mahajan K. Takayasu arteritis presenting with total occlusion of the left main coronary artery ostium: an extremely rare occurrence. BMJ Case Rep 2016; 2016:10.1136/bcr-2016-214531. [PMID: 27084916 DOI: 10.1136/bcr-2016-214531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A young 18-year-old female patient with exertional angina and claudication of the upper limbs was subjected to angiography. Bruits were auscultated over the bilateral renal arteries, right subclavian and right common carotid arteries. There was asymmetry of peripheral pulses. Laboratory parameters demonstrated a high erythrocyte sedimentation rate and C reactive protein. An aortic angiogram revealed a typical picture of Takayasu arteritis with bilateral subclavian, common carotid and renal involvement. A coronary angiogram was performed which showed total occlusion of the left main coronary artery. There was retrograde filling of the left coronary artery on right coronary artery injection up to the ostium of the left main coronary artery. Since the markers for disease activity were high, the patient was started on steroids and urgent coronary artery bypass grafting was planned. Unfortunately, the patient refused urgent intervention and was later lost to follow-up. This case describes an extremely rare occurrence of total occlusion of the left main coronary artery ostium in a patient with Takayasu arteritis.
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Affiliation(s)
- Arvind Kandoria
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Meenakshi Kandoria
- Department of Obstetrics and Gynaecology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Neeraj Ganju
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Kunal Mahajan
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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Mandal SK, Gupta N, Goel R, Nair A, Arya S, Ganapati A, Mathew AJ, Joseph G, Nindugala Keshava S, Danda D. Imaging in Takayasu arteritis. INDIAN JOURNAL OF RHEUMATOLOGY 2015. [DOI: 10.1016/j.injr.2015.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Watanabe Y, Miyata T, Tanemoto K. Current Clinical Features of New Patients With Takayasu Arteritis Observed From Cross-Country Research in Japan: Age and Sex Specificity. Circulation 2015; 132:1701-9. [PMID: 26354799 DOI: 10.1161/circulationaha.114.012547] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 04/03/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND The clinical features of newly diagnosed Japanese patients with Takayasu arteritis and its age or sex specificities are unknown. METHODS AND RESULTS We analyzed information from nationwide registration forms submitted by patients with Takayasu arteritis between April 2001 and March 2011 as part of a research program by the Japanese Ministry of Health, Labor and Welfare. Among the 7779 patients who submitted their forms, 1372 newly registered patients with Takayasu arteritis were enrolled; 83.8% were female. The median age at onset was 35 years, which was significantly higher in male patients (median, 43.5 years) than in female patients (median, 34 years; P<0.001). Local symptoms and findings were most commonly observed in the cervicobrachial area, with more complaints in the head or neck than in the upper limbs. Approximately 85% of the patients had vascular involvements in the aortic arch or its major branches; many young female patients had localized lesions. Although male patients had extensive aortic lesions or aneurysms with more complications, localized abdominal lesions were relatively more frequent in male patients with age at onset >40 years than in other age-sex groups. Disease statuses were severe in patients who registered at ≥1 year after onset. CONCLUSIONS The proportions of male patients and patients with elderly onset increased in newly diagnosed patients with Takayasu arteritis. Their clinical and angiographic features differed according to onset age and sex.
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Affiliation(s)
- Yoshiko Watanabe
- From First Department of Physiology (Y.W.) and Department of Cardiovascular Surgery (K.T.), Kawasaki Medical School, Kurashiki, Japan; and Vascular Center, Sanno Hospital and Sanno Medical Center, Tokyo, Japan (T.M.).
| | - Tetsuro Miyata
- From First Department of Physiology (Y.W.) and Department of Cardiovascular Surgery (K.T.), Kawasaki Medical School, Kurashiki, Japan; and Vascular Center, Sanno Hospital and Sanno Medical Center, Tokyo, Japan (T.M.)
| | - Kazuo Tanemoto
- From First Department of Physiology (Y.W.) and Department of Cardiovascular Surgery (K.T.), Kawasaki Medical School, Kurashiki, Japan; and Vascular Center, Sanno Hospital and Sanno Medical Center, Tokyo, Japan (T.M.)
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Mason JC, Libby P. Cardiovascular disease in patients with chronic inflammation: mechanisms underlying premature cardiovascular events in rheumatologic conditions. Eur Heart J 2015; 36:482-9c. [PMID: 25433021 PMCID: PMC4340364 DOI: 10.1093/eurheartj/ehu403] [Citation(s) in RCA: 262] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
A variety of systemic inflammatory rheumatic diseases associate with an increased risk of atherosclerotic events and premature cardiovascular (CV) disease. Although this recognition has stimulated intense basic science and clinical research, the precise nature of the relationship between local and systemic inflammation, their interactions with traditional CV risk factors, and their role in accelerating atherogenesis remains unresolved. The individual rheumatic diseases have both shared and unique attributes that might impact CV events. Understanding of the positive and negative influences of individual anti-inflammatory therapies remains rudimentary. Clinicians need to adopt an evidence-based approach to develop diagnostic techniques to identify those rheumatologic patients most at risk of CV disease and to develop effective treatment protocols. Development of optimal preventative and disease-modifying approaches for atherosclerosis in these patients will require close collaboration between basic scientists, CV specialists, and rheumatologists. This interface presents a complex, important, and exciting challenge.
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Affiliation(s)
- Justin C Mason
- Vascular Sciences Unit and Rheumatology Section, Imperial Centre for Translational and Experimental Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - Peter Libby
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Hartlage GR, Palios J, Barron BJ, Stillman AE, Bossone E, Clements SD, Lerakis S. Multimodality Imaging of Aortitis. JACC Cardiovasc Imaging 2014; 7:605-19. [DOI: 10.1016/j.jcmg.2014.04.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 03/11/2014] [Accepted: 04/04/2014] [Indexed: 02/08/2023]
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Comarmond C, Dessault O, Devaux JY, Costedoat-Chalumeau N, Resche-Rigon M, Isnard R, Koskas F, Cacoub P, Saadoun D. Myocardial Perfusion Imaging in Takayasu Arteritis. J Rheumatol 2013; 40:2052-60. [DOI: 10.3899/jrheum.130308] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.Myocardial perfusion defects using scintigraphy have been frequently observed in patients with Takayasu arteritis (TA) without coronary stenosis. The aim of our study was to evaluate coronary microcirculation in TA using thallium-201 (201Tl) myocardial scintigraphy and dipyridamole (DPM) as vasodilator agent.Methods.Twenty-five consecutive patients with TA were prospectively recruited. They were asymptomatic for cardiac issues and examined using 201Tl myocardial scintigraphy at rest and after coronary artery vasodilation with intravenous DPM. Factors associated with improvement in myocardial perfusion after DPM were identified in patients with TA.Results.Among 25 patients with TA, 21 (84%) had 201Tl myocardial perfusion defects and 4 (16%) had normal resting myocardial perfusion. Using a 17-segments model for quantitative image analysis, DPM significantly improved resting 201Tl myocardial perfusion in 14 patients (61%) versus 9 patients without improvement (39%). We were able to examine coronary artery stenoses in 11 patients, including 10 patients with thallium perfusion defects, and significant coronary artery stenoses were present in only 2 patients (18.2%). No significant difference was found in traditional cardiovascular risk factors between TA patients with or without improvement of myocardial perfusion after DPM. The absence of improvement in myocardial perfusion after DPM tended to be closely associated with specific features and prognostic factors of TA, such as aortic regurgitation at diagnosis, renovascular hypertension, longer duration of TA disease, and male sex.Conclusion.We found the significantly high prevalence of myocardial perfusion defects mostly improved after vasodilation with DPM, which may indicate the major role of microcirculatory dysfunction in myocardial ischemia in TA.
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Isobe M. Takayasu arteritis revisited: Current diagnosis and treatment. Int J Cardiol 2013; 168:3-10. [DOI: 10.1016/j.ijcard.2013.01.022] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 12/21/2012] [Accepted: 01/19/2013] [Indexed: 11/29/2022]
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Mohan S, Poff S, Torok KS. Coronary artery involvement in pediatric Takayasu's arteritis: Case report and literature review. Pediatr Rheumatol Online J 2013; 11:4. [PMID: 23398983 PMCID: PMC3575318 DOI: 10.1186/1546-0096-11-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 02/05/2013] [Indexed: 11/29/2022] Open
Abstract
Takayasu's arteritis (TA) is a form of chronic vasculitis that typically occurs in young adult Asian females, but it can also present in younger patients not fitting this classic profile. In these cases, the sequelae are generally similar to those found in adults. The disease predominantly affects the aorta and its primary branches. However, the coronary arteries are also affected in up to 20% of cases, which may precipitate myocardial infarction. Imaging of the coronary arteries therefore becomes critically important in the evaluation of a patient with possible Takayasu's arteritis. We present a case of a pediatric patient with TA who had no symptoms of angina but who was found to have significant coronary artery involvement on diagnostic imaging. This necessitated tailoring of traditional management.
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Affiliation(s)
- Shaun Mohan
- Division of Pediatric Rheumatology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, 15224, Pittsburgh, PA, USA.
| | - Sarah Poff
- Division of Pediatric Rheumatology, Children’s Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, 15224, Pittsburgh, PA, USA
| | - Kathryn S Torok
- Division of Pediatric Rheumatology, Children’s Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, 15224, Pittsburgh, PA, USA
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Mavrogeni S, Dimitroulas T, Chatziioannou SN, Kitas G. The Role of Multimodality Imaging in the Evaluation of Takayasu Arteritis. Semin Arthritis Rheum 2013; 42:401-12. [DOI: 10.1016/j.semarthrit.2012.07.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 06/30/2012] [Accepted: 07/14/2012] [Indexed: 11/26/2022]
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Cardiovascular disease due to accelerated atherosclerosis in systemic vasculitides. Best Pract Res Clin Rheumatol 2013; 27:33-44. [DOI: 10.1016/j.berh.2012.12.004] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 12/22/2012] [Accepted: 12/27/2012] [Indexed: 02/08/2023]
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Zhu FP, Luo S, Wang ZJ, Jin ZY, Zhang LJ, Lu GM. Takayasu arteritis: imaging spectrum at multidetector CT angiography. Br J Radiol 2013; 85:e1282-92. [PMID: 23175494 DOI: 10.1259/bjr/25536451] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Takayasu arteritis is a chronic, idiopathic, inflammatory disease that primarily affects large vessels, such as the aorta and its major branches and the pulmonary and coronary arteries. The non-specific inflammation of involved vessels usually leads to concentric wall thickening, fibrosis and thrombus formation. Diseased arteries become stenotic or occluded, undergo vascular remodelling or develop aneurysms. According to the involvement of arteries, six types of Takayasu arteritis are documented. The purpose of this pictorial review is to illustrate the various multidetector CT angiography appearances of Takayasu arteritis and to discuss the differential diagnosis.
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Affiliation(s)
- F P Zhu
- Department of Medical Imaging, Jinling Hospital, Clinical School of South Medical University, Nanjing, Jiangsu Province, China
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Chaigne-Delalande S, de Menthon M, Lazaro E, Mahr A. Artérite à cellules géantes et maladie de Takayasu : aspects épidémiologiques, diagnostiques et thérapeutiques. Presse Med 2012; 41:955-65. [DOI: 10.1016/j.lpm.2012.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 07/30/2012] [Accepted: 07/30/2012] [Indexed: 02/04/2023] Open
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Piga M, Ruffini L, Salvarani C, Mathieu A. Myocardial positron emission tomography/computed tomography scan revealing right coronary artery involvement in large vessel vasculitis. J Rheumatol 2012; 39:1761-1763. [PMID: 22859537 DOI: 10.3899/jrheum.120353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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