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Liao H, Zhang N, Pan L, Du J, Liu J, Zheng Y. Predictors for pulmonary artery involvement in Takayasu arteritis and its cluster analysis. Arthritis Res Ther 2023; 25:9. [PMID: 36639641 PMCID: PMC9840297 DOI: 10.1186/s13075-022-02987-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/31/2022] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To investigate the clinical characteristics and the site of pulmonary involvement in Takayasu arteritis (TAK) patients with pulmonary artery involvement (PAI). METHODS We retrospectively investigated data of 141 TAK patients. The clinical and image data of the patients with and without PAI were analyzed and compared. The patients were followed up. The major outcome was all-cause mortality. The minor outcome was exacerbation or new occurrence of PAI, which leads to disease progression events. RESULTS For the 141 TAK patients considered, PAI was detected in 65 (46.1%) patients. TAK patients with PAI had a significantly higher cumulative incidence of events than those without PAI (P < 0.001). The frequencies of the following were significantly higher in TAK with PAI than those in TAK without PAI: disease duration [median 96 months (IQR: 24-174) vs. median 42 months (IQR: 6-120); P = 0.012], hemoptysis (10.8% vs. 1.32%; P = 0.040), oppression in the chest (40.0% vs. 21.1%; P = 0.014), fever (23.1% vs. 9.21%; P = 0.024), Mycobacterium tuberculosis infection (21.5% vs. 6.57%; P = 0.010), pulmonary hypertension (PAH) (21.5% vs. 2.6%; P < 0.001), pulmonary infarction (41.5% vs. 0%; P < 0.001), and hypoxemia (18.5% vs. 1.3%; P < 0.001). Multivariate logistic regression analysis of data of TAK patients with symptom presentation showed that oppression in the chest (OR: 2.304; 95% CI: 1.024-5.183; P = 0.044) and thoracic aorta involvement (OR: 2.819; 95% CI: 1.165-6.833; P = 0.022) were associated with PAI. The cluster analysis performed for data of TAK patients with PAI revealed that the cluster characterized as the upper lobe of the right lung (Cluster1) had the worst prognosis. CONCLUSION In TAK, PAI is associated with thoracic aorta involvement. In TAK patients with PAI, the involvement of the upper lobe of the right lung is characterized with the worst prognosis.
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Affiliation(s)
- Hua Liao
- grid.24696.3f0000 0004 0369 153XDepartments of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Nan Zhang
- grid.24696.3f0000 0004 0369 153XDepartments of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lili Pan
- grid.24696.3f0000 0004 0369 153XDepartments of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Juan Du
- grid.24696.3f0000 0004 0369 153XDepartments of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiayi Liu
- grid.24696.3f0000 0004 0369 153XDepartments of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yi Zheng
- Departments of Rheumatology, Beijing Chaoyang Hospital, Capital Medical University, #8 Gong-Ti South Road, Chaoyang District, Beijing, 100020, China.
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Huang Z, Wang M, Hu F, Liu X. Long-Term Outcomes After Percutaneous Transluminal Pulmonary Angioplasty in Patients With Takayasu Arteritis and Pulmonary Hypertension. Front Immunol 2022; 13:828863. [PMID: 35359930 PMCID: PMC8961863 DOI: 10.3389/fimmu.2022.828863] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/21/2022] [Indexed: 01/20/2023] Open
Abstract
Objective To investigate the long-term efficacy of percutaneous transluminal pulmonary angioplasty (PTPA) in patients with Takayasu arteritis (TA) and pulmonary artery stenosis and pulmonary hypertension (PH). Methods Data from 183 lesions from 79 surgeries performed on 32 patients with TA and PH were analyzed. Symptoms, laboratory investigation results, World Health Organization (WHO) functional class, 6-min walk distance (6 MWD), hemodynamic parameters, and prognosis were analyzed at baseline and follow-up. Results The mean (± SD) age of the 32 patients (28 female, 4 male) was 42.8 ± 11.9 years, and the median follow-up was 49.5 months (interquartile range, 26–71 months). Compared with baseline, changes in total bilirubin, N-terminal pro-brain natriuretic peptide (NT-proBNP) level, 6 MWD, and WHO score functional class demonstrated significant differences (P<0.001). Echocardiography findings, right and left ventricular diameter, tricuspid annular plane systolic excursion, and estimated pulmonary artery systolic pressure were all improved (P=0.016, P<0.001, P<0.001, and P=0.005, respectively). Importantly, repeat right heart catheterization revealed that mean pulmonary artery pressure, pulmonary vascular resistance, and cardiac index also improved significantly at follow-up (P<0.001, P<0.001, and P=0.011, respectively). Pulmonary angiography revealed post-procedure restenosis in 64 (35.0%) lesions underwent PTPA within three to six months. Among three patients who underwent stent implantation, one experienced restenosis. Two patients died during the follow-up period, one from aggravation of right heart failure after lung infection, and the other in a traffic accident. Conclusions Results of this study indicated that PTPA significantly improved clinical symptoms, exercise tolerance, and hemodynamic parameters in patients with TA pulmonary artery stenosis and PH. More importantly, reperfusion pulmonary edema significantly decreased, and no patient died of PTPA-related complications with guidance from the pressure wire.
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Li J, Liu L, Song LX, Zhang YH, Liu Y, Gu S, Wang JF, Huang Q, Ma ZH, Guo XJ, Yang MF, Jiang W, Li F, Yang YH. Clinical Features and Outcomes of Pulmonary Artery Sarcoma. Heart Lung Circ 2021; 31:230-238. [PMID: 34417115 DOI: 10.1016/j.hlc.2021.06.448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 05/28/2021] [Accepted: 06/08/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVES A retrospective cohort study was designed to describe the clinical features and outcomes of pulmonary artery sarcoma (PAS). METHODS Twenty-two (22) consecutive patients diagnosed with PAS by pathological examination were enrolled and followed up until they died or until January 2020. The medical records were retrospectively reviewed to evaluate the clinical characteristics, image findings, and outcomes. RESULTS 1) Twenty-one (21, 95.5%) patients were firstly misdiagnosed. Dyspnoea was the most common presenting symptom (19 of 22, 86.4%). 2) Filling defects in the right pulmonary artery were seen in 17 patients (77.3%) with computed tomography pulmonary angiography or magnetic resonance pulmonary angiography. Among those patients, 14 underwent positron emission tomography-computed tomography detection and 13 (92.9%) were found to have increased uptake value in the pulmonary artery. 3) The median survival (from diagnosis to death or January 2020) of the total series was 11.6 months (range, 0.7-68.5 months). The estimated cumulative survival rates at 1, 2, and 3 years were 52.6%, 32.8%, and 19.7%, respectively. Patients who received surgery and/or chemo-radiotherapy treatment had a better survival rate compared with patients without treatment (the estimated cumulative survival rates at 1, 2, and 3 years were 60.3%, 39.1%, and 29.3%, respectively, vs 33.3%, 16.6%, and 0, accordingly) and better survival time (median survival 17.02 vs 3.16 months, respectively) (p=0.025). CONCLUSIONS Pulmonary artery sarcoma is easily misdiagnosed, as the symptoms and routine image detection are nonspecific. Positron emission tomography-computed tomography may be helpful in diagnosis. Surgery and/or chemo-radiotherapy offer a chance for better outcomes.
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Affiliation(s)
- Jifeng Li
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China; Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China; Department of Respiratory Disease, Capital Medical University, Beijing, P. R. China. https://twitter.com/JifengLi5
| | - Lin Liu
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China; Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China; Department of Respiratory Disease, Capital Medical University, Beijing, P. R. China
| | - Ling-Xie Song
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China
| | - Yu-Hui Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China; Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China; Department of Respiratory Disease, Capital Medical University, Beijing, P. R. China
| | - Yan Liu
- Department of Cardiac Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China
| | - Song Gu
- Department of Cardiac Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China
| | - Jian-Feng Wang
- Department of Interventional Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China
| | - Qiang Huang
- Department of Interventional Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China
| | - Zhan-Hong Ma
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China
| | - Xiao-Juan Guo
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China
| | - Min-Fu Yang
- Department of Nuclear Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China
| | - Wei Jiang
- Department of Echocardiography, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China
| | - Feng Li
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China
| | - Yuan-Hua Yang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China; Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China; Department of Respiratory Disease, Capital Medical University, Beijing, P. R. China.
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Patel A, Velamakanni SM, Parikh RM, Pandya S, Patel T. The Role of Echocardiography in Evaluation of Takayasu's Arteritis: A Report of Two Cases. Cureus 2021; 13:e15286. [PMID: 34221751 PMCID: PMC8237925 DOI: 10.7759/cureus.15286] [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] [Indexed: 11/05/2022] Open
Abstract
Takayasu's arteritis (TA) is a large-vessel chronic inflammatory vasculitis that leads to thrombotic vascular occlusion. This can lead to varied presentations including limb claudication, ischemic stroke, hypertension, and heart failure. Although contrast computed tomography angiography is the main modality for imaging of the aorta and its branches, transthoracic echocardiography can be an easy-to-access, point-of-care, initial screening tool for evaluating the aorta and other cardiac structures. We present echocardiographic images from two cases that demonstrate the important cardiac structural and vascular afflictions of TA.
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Affiliation(s)
- Aman Patel
- Cardiology, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
| | | | - Rinal M Parikh
- Internal Medicine, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
| | - Sapan Pandya
- Rheumatology, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
| | - Tejas Patel
- Cardiology, Apex Heart Institute, Ahmedabad, IND.,Cardiology, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
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Wang YJ, Ma LL, Liu Y, Yan Y, Sun Y, Wang YS, Dai XM, Ji ZF, Ma LY, Chen HY, Jiang LD. Risk assessment model for heart failure in Chinese patients with Takayasu's arteritis. Clin Rheumatol 2021; 40:4117-4126. [PMID: 34021842 DOI: 10.1007/s10067-021-05745-0] [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: 11/09/2020] [Revised: 03/22/2021] [Accepted: 04/19/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We aimed to construct and validate a risk assessment model to identify risk factors for heart failure (HF) in patients with Takayasu's arteritis (TAK). METHODS Three hundred sixty-five patients with TAK were recruited in the East China Takayasu Arteritis Cohort from January 2012 to December 2019. Patients were assigned into training and validation sets following a 2:1 ratio according to the date of enrollment. Clinical characteristics were compared between heart failure (HF) and non-HF subgroups in the training set, and a risk assessment model for HF and its scoring algorithm was established based on logistic regression, which was tested in the validation set. RESULTS Among total of 74 (20.27%) TAK patients exhibited HF, and 55 cases (74.32%) were in the training set. The risk factors for HF of TAK patients included onset age >38 years, serum tumor necrosis factor (TNF)-α concentration >10 pg/ml, aortic valve involvement, coronary artery involvement, and pulmonary hypertension. We constructed the model without TNF-α (Model 1) and with TNF-α (Model 2). Patients in the training set with the score ≥ 3 appeared to be associated with an increased risk of HF with an area under curve (AUC) of 0.88 and 0.90 in Model 1 and Model 2 respectively. The AUC reached to 0.88 and 0.89 in the validation set that proved the accuracy of the model. CONCLUSIONS We presented a risk assessment model of HF in TAK, which may help clinicians alert the complication of HF in the patients with specifically cardiac impairments. Key Points • Heart failure was not rare in Chinese Takayasu's arteritis patients, and there were approximately 20% of patients with heart failure in ECTA cohort. • Cardiac involvements on echocardiography include pathological valvular and atrioventricular abnormalities. • The onset age >38 years, serum tumor necrosis factor (TNF)-α concentration >10 pg/ml, aortic valve involvement, coronary artery involvement, and pulmonary hypertension were risk factors for heart failure in Takayasu's arteritis patients. • We constructed the model without TNF-α (Model 1) and with TNF-α (Model 2). Patients with the risk assessment model score of ≥ 3 appeared to be associated with an increased risk of heart failure.
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Affiliation(s)
- Yu-Jiao Wang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Li-Li Ma
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.,Evidence-base Medicine Center, Fudan University, Shanghai, People's Republic of China
| | - Yun Liu
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Yan Yan
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Ying Sun
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Yong-Shi Wang
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xiao-Min Dai
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Zong-Fei Ji
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Ling-Ying Ma
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Hui-Yong Chen
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Lin-Di Jiang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China. .,Evidence-base Medicine Center, Fudan University, Shanghai, People's Republic of China.
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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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Kong X, Ma L, Lv P, Cui X, Chen R, Ji Z, Chen H, Lin J, Jiang L. Involvement of the pulmonary arteries in patients with Takayasu arteritis: a prospective study from a single centre in China. Arthritis Res Ther 2020; 22:131. [PMID: 32503678 PMCID: PMC7275430 DOI: 10.1186/s13075-020-02203-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/28/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Takayasu arteritis (TA) is a large vessel vasculitis that can involve pulmonary arteries (PAs). We studied multiple clinical characteristics related to pulmonary artery involvement (PAI) in TA patients. METHODS We enrolled 216 patients with TA from a large prospective cohort. PAI was assessed in each patient based on data from magnetic resonance angiography/computed tomography angiography. Pulmonary hypertension, cardiac function, and pulmonary parenchymal lesions were evaluated further in patients with PAI based on echocardiography, the New York Heart Association Functional Classification, and pulmonary computed tomography, respectively. These abnormalities related to PAI were followed up to evaluate treatment effects. RESULTS PAI was detected in 56/216 (25.93%) patients, which involved the pulmonary trunk, main PAs, and small vessels in the lungs. Among patients with PAI, 28 (50%) patients were accompanied by pulmonary hypertension, which was graded as 'severe' in 9 (16.07%), 'moderate' in 10 (17.86%), and mild in 9 (16.07%). Twenty-six (46.43%) patients showed advanced NYHA function (III, 20, 35.71%; IV, 6, 10.71%). Furthermore, 21 (37.50%) patients presented with abnormal pulmonary parenchymal lesions in the area corresponding to PAI (e.g. the mosaic sign, infarction, bronchiectasis). During follow-up, two patients died due to heart failure and pulmonary thrombosis. In the remaining patients, the abnormalities mentioned above improved partially after routine treatment. CONCLUSIONS PAI is common in TA patients. PAI can cause pulmonary hypertension, cardiac insufficiency, and pulmonary parenchymal lesions, which worsen patients' prognosis.
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Affiliation(s)
- Xiufang Kong
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Lili Ma
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Peng Lv
- Department of Radiology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Xiaomeng Cui
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Rongyi Chen
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Zongfei Ji
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Huiyong Chen
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Jiang Lin
- Department of Radiology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Lindi Jiang
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China. .,Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, Shanghai, China.
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He Y, Lv N, Dang A, Cheng N. Pulmonary Artery Involvement in Patients with Takayasu Arteritis. J Rheumatol 2019; 47:264-272. [PMID: 31092716 DOI: 10.3899/jrheum.190045] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study was performed to explore the clinical manifestations and longterm prognosis in patients with Takayasu arteritis (TA) with pulmonary artery involvement (PAI). METHODS The medical records of 194 patients with TA who underwent traditional catheter angiography or computed tomography of pulmonary artery from 2009 to 2016 were retrospectively reviewed. The clinical manifestations, angiographic features, and mortality of 128 patients with TA with PAI were further analyzed. RESULTS Patients with TA with PAI had a higher risk of pulmonary hypertension (PH) than patients with TA alone (61.7% vs 7.6%, p < 0.001). Patients with PAI and PH more frequently developed dyspnea, hemoptysis, and lower limbs edema (all p < 0.05) than those without PH. Patients with PH also had a higher incidence of bilateral PAI (84.8% vs 34.7%, p < 0.001) and a higher pulmonary artery obstruction index [23 (interquartile range 20-27) vs 10 (6-15), p < 0.001]. Left heart disease was presented in 39 (30.5%) patients with TA with PAI. During the median followup of 38 (21-58) months, 19 and 2 deaths occurred among patients with and without PH, respectively. Among patients with PAI, the mortality rate was 7 times higher in patients with than without PH (p = 0.009). Independent predictors of mortality were the disease duration (p = 0.047), New York Heart Association class III/IV (p = 0.019), right ventricular systolic dysfunction (p = 0.019), and respiratory failure (p = 0.007). CONCLUSION Patients with TA with PAI have a higher risk of developing PH than patients with TA alone. The presence of PH in patients with PAI increases the risk of early mortality.
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Affiliation(s)
- Yanru He
- From the Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Beijing, China.,Y. He, MD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; N. Lv, MD, PhD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; A. Dang, MD, PhD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; N. Cheng, MD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College
| | - Naqiang Lv
- From the Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Beijing, China.,Y. He, MD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; N. Lv, MD, PhD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; A. Dang, MD, PhD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; N. Cheng, MD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College
| | - Aimin Dang
- From the Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Beijing, China. .,Y. He, MD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; N. Lv, MD, PhD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; A. Dang, MD, PhD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; N. Cheng, MD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College.
| | - Nan Cheng
- From the Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Beijing, China.,Y. He, MD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; N. Lv, MD, PhD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; A. Dang, MD, PhD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College; N. Cheng, MD, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, CAMS and Peking Union Medical College
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Clinical and imaging manifestations of Takayasu's arteritis with pulmonary hypertension: A retrospective cohort study in China. Int J Cardiol 2019; 276:224-229. [DOI: 10.1016/j.ijcard.2018.08.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/15/2018] [Accepted: 08/13/2018] [Indexed: 12/12/2022]
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10
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Adams TN, Zhang D, Batra K, Fitzgerald JE. Pulmonary manifestations of large, medium, and variable vessel vasculitis. Respir Med 2018; 145:182-191. [PMID: 30509707 DOI: 10.1016/j.rmed.2018.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 09/14/2018] [Accepted: 11/06/2018] [Indexed: 02/01/2023]
Abstract
The hallmark of vasculitis is autoimmune inflammation of blood vessels and surrounding tissues, resulting in an array of constitutional symptoms and organ damage. The lung is commonly targeted in the more familiar ANCA-associated small vessel vasculitidies, but large and medium vessel vasculitides, including Takayasu arteritis, giant cell arteritis, polyarteritis nodosa, Behcet's disease, and necrotizing sarcoid granulomatosis, may also feature prominent pulmonary involvement. Pulmonary manifestations of these conditions include pulmonary arterial aneurysms, pulmonary hypertension, diffuse alveolar hemorrhage, pulmonary nodules, and parenchymal infiltrates. An understanding of the diverse manifestations of vasculitis and a high index of clinical suspicion are essential to avoid delays in disease recognition that may result in permanent or life threatening morbidity. In this review, we outline the general clinical manifestations, pulmonary manifestations, diagnostic workup, imaging findings, and treatment of medium, large, and variable vessel vasculitides.
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Affiliation(s)
- Traci N Adams
- University of Texas Southwestern Medical Center, Department of Pulmonary and Critical Care Medicine, United States.
| | - Da Zhang
- University of Texas Southwestern Medical Center, Department of Pulmonary and Critical Care Medicine, United States
| | - Kiran Batra
- University of Texas Southwestern Medical Center, Department of Radiology, United States
| | - John E Fitzgerald
- University of Texas Southwestern Medical Center, Department of Pulmonary and Critical Care Medicine, United States
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Tanimura S, Kato M, Abe N, Ohira H, Tsujino I, Atsumi T. Successful treatment of tocilizumab-resistant large vessel pulmonary arteritis with infliximab. Immunol Med 2018; 41:39-42. [DOI: 10.1080/09114300.2018.1451616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Shun Tanimura
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaru Kato
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuya Abe
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Ohira
- First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Ichizo Tsujino
- First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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12
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Jiang W, Yang Y, Lv X, Li Y, Ma Z, Li J. Echocardiographic characteristics of pulmonary artery involvement in Takayasu arteritis. Echocardiography 2017; 34:340-347. [PMID: 28139021 PMCID: PMC5347968 DOI: 10.1111/echo.13464] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Up to 50% patients with Takayasu arteritis have pulmonary artery involvement. Hence, the early identification of pulmonary artery involvement to facilitate prompt treatment is required. METHODS This retrospective study was performed in patients diagnosed with Takayasu arteritis between January 2009 and January 2016. Pulmonary artery involvement was confirmed with computed tomographic pulmonary angiography. Images from transthoracic echocardiography in three windows (suprasternal right pulmonary artery long-axis view, parasternal aortic short-axis view, and subxiphoid view) were documented and analyzed. RESULTS A total of 27 patients had Takayasu arteritis and pulmonary artery involvement. Characteristic changes identified by echocardiography included luminal medium-to-high echogenic signals, stenosis, and occlusion, as well as intimal thickening. Left pulmonary artery involvement was revealed in the parasternal aortic short-axis view. Right pulmonary artery involvement was best observed in the suprasternal right pulmonary artery long-axis view, with complementary views from the parasternal aortic short-axis and subxiphoid angles. Pulmonary trunk involvement was not observed in all three windows. CONCLUSIONS Transthoracic echocardiography could be a useful noninvasive test to detect pulmonary artery involvement in patients with Takayasu arteritis.
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Affiliation(s)
- Wei Jiang
- Department of Echocardiography, Heart Center, Capital Medical University, Chaoyang Hospital, Beijing, China
| | - Yuanhua Yang
- Department of Respiratory and Critical Care Medicine, Capital Medical University, Chaoyang Hospital, Beijing, China
| | - Xiuzhang Lv
- Department of Echocardiography, Heart Center, Capital Medical University, Chaoyang Hospital, Beijing, China
| | - Yidan Li
- Department of Echocardiography, Heart Center, Capital Medical University, Chaoyang Hospital, Beijing, China
| | - Zhanhong Ma
- Department of Radiology, Capital Medical University, Chaoyang Hospital, Beijing, China
| | - Jifeng Li
- Department of Respiratory and Critical Care Medicine, Capital Medical University, Chaoyang Hospital, Beijing, China
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