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Liu L, Li J, Gan T, Yang Y, Tian X. Isolated Coronary Arteritis in Adults: a Single-Center Experience from China. J Cardiovasc Transl Res 2023; 16:1184-1193. [PMID: 37097590 DOI: 10.1007/s12265-023-10388-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 04/14/2023] [Indexed: 04/26/2023]
Abstract
Isolated coronary arteritis (ICA) is an extremely rare and life-threatening vasculitis with only a limited number of reports in the literature. We retrospectively reviewed the clinical data of 10 ICA patients in our center from 2012 to 2022 and compared them with patients with Takayasu arteritis who presented with coronary arteritis initially (TAK-CA patients). We found that ICA predominantly affected women and most commonly involved the ostium and the proximal segment of the coronary arteries, causing mainly stenotic lesions. The C-reactive protein and erythrocyte sedimentation rate were grossly normal and significantly lower than those of TAK-CA patients (p = 0.027, p = 0.009, respectively). Intravascular ultrasound imaging showed superiority in differentiating coronary vasculitis from atherosclerosis. Restenosis of the coronary arteries occurred rapidly if not treated promptly and appropriately. Systemic glucocorticoid combined with immunosuppressive agents, especially cyclophosphamide, was a promising strategy for treating ICA.
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Affiliation(s)
- Lingyu Liu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China
| | - Jing Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China
| | - Tianpeng Gan
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yunjiao Yang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China
| | - Xinping Tian
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China.
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China.
- State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital (PUMCH), Beijing, 100730, China.
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Patankar A, Samant R. Erythema nodosum: A harbinger of takayasu arteritis. INDIAN JOURNAL OF RHEUMATOLOGY 2023. [DOI: 10.4103/injr.injr_200_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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Kikuchi S, Okada K, Hibi K, Maejima N, Yabu N, Uchida K, Tamura K, Kimura K. Coronary arteritis: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-6. [PMID: 32352046 PMCID: PMC7180521 DOI: 10.1093/ehjcr/ytaa011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/04/2019] [Accepted: 01/14/2020] [Indexed: 12/02/2022]
Abstract
Background The present article describes two cases of patients with coronary arteritis (CA) whose identification of CA diagnosis (late vs. early) resulted in different clinical courses and outcomes. Case summary Case 1 is a 53-year-old woman with multiple coronary risk factors who was admitted with acute coronary syndrome (ACS) and significant stenosis in the left main trunk (LMT). Although clues suggested arteritis (LMT lesion without any other stenosis, occlusion of left internal thoracic artery, etc.), the diagnosis of CA (coronary involvement of unclassified arteritis) was delayed and revascularization, including coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), was performed under uncontrolled inflammatory status. As a result, Case 1 experienced repeated ACS episodes due to graft failure and in-stent restenosis, and repeatedly underwent PCI. Case 2 is a 76-year-old woman with no significant coronary risk factors who was admitted with ACS. This patient was successfully diagnosed with coronary involvement of Takayasu arteritis before revascularization. Coronary artery bypass grafting was performed after stabilizing inflammation with prednisolone, and the patient remains angina-free beyond 1-year post-CABG. In both cases, intravascular imaging clearly identified the localization and degree of inflammation related to CA by demonstrating specific findings (ambiguous typical three-layer structure of arterial wall and extended low-echoic areas within adventitia). Discussion Accurate and early diagnosis with meticulous diagnostic and therapeutic strategies appear to be important for favourable clinical outcomes in the medical treatment of patients with coronary involvement of arteritis. Intravascular imaging has the potential to contribute to optimizing clinical management of CA.
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Affiliation(s)
- Shinnosuke Kikuchi
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Kozo Okada
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Nobuhiko Maejima
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Naoto Yabu
- Division of Cardiolovascular Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Keiji Uchida
- Division of Cardiolovascular Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
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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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Sun T, Zhang H, Ma W, Yang L, Jiang X, Wu H, Hui R, Zheng D. Coronary Artery Involvement in Takayasu Arteritis in 45 Chinese Patients. J Rheumatol 2013; 40:493-7. [DOI: 10.3899/jrheum.120813] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.We investigated the clinical characteristics, potential difficulties in diagnosis, and therapy for coronary artery involvement in patients with Takayasu arteritis (TA).Methods.Of 587 consecutive patients hospitalized with TA from 1998 to 2011, those found to have > 50% reduction of diameter of coronary artery by angiography were recruited. We defined the first finding of coronary involvement as baseline. The clinical features, laboratory data, coronary angiographic findings, treatment, and followup outcomes were summarized retrospectively.Results.A total of 45 (7.7%, 45/587) patients with coronary involvement were identified, including 40 with typical angina, and 15 with myocardial infarction. Some had complications such as peripheral vascular murmur, pulseless disease, and hypertension. The average age at onset of cardiac symptoms was 40.3 ± 12.8 years (range 15–64) and 36 were female. At admission, erythrocyte sedimentation rates were elevated in 27 patients (60%) and C-reactive protein levels in 23 (51.1%). The ostia (37.4%) and proximal segments (33.3%) of coronary artery were most frequently involved. The treatment was stent implantation in 10 patients and coronary artery bypass grafting in 13. One female patient suffered sudden death during the angiography. During a mean followup of 5.8 ± 4.5 years, 8 patients died.Conclusion.Coronary artery involvement in TA that leads to cardiovascular events, especially to cardiovascular death, is not rare. Early diagnosis and therapy should be emphasized.
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Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology,American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons,and Society for Vascular Medicine. J Am Coll Cardiol 2010; 55:e27-e129. [PMID: 20359588 DOI: 10.1016/j.jacc.2010.02.015] [Citation(s) in RCA: 998] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010; 121:e266-369. [PMID: 20233780 DOI: 10.1161/cir.0b013e3181d4739e] [Citation(s) in RCA: 1175] [Impact Index Per Article: 83.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abstract
We report an unusual case of concomitant Takayasu's arteritis and Marfan syndrome manifesting left main coronary ostial obstruction and annuloaortic ectasia. Simultaneous surgical treatment consisting of left coronary ostium endarterectomy, coronary artery bypass grafting, and Bentall operation was performed. This case is unique in that the cardiovascular manifestations of Takayasu's arteritis and Marfan syndrome were both simultaneously presented and surgically treated.
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Affiliation(s)
- Kyung-Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Korea.
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Jolly M, Bartholomew JR, Flamm SD, Olin JW. Angina and coronary ostial lesions in a young woman as a presentation of Takayasu's arteritis. CARDIOVASCULAR SURGERY (LONDON, ENGLAND) 1999; 7:443-6. [PMID: 10430528 DOI: 10.1016/s0967-2109(99)00010-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Diagnostic considerations in young patients presenting with coronary artery disease have conventionally included familial dyslipidemias, lipoprotein(a) elevation, hyperhomocysteinemia, cocaine toxicity, hypercoagulable states, connective tissue disorders, vasculitis and the presence of other established risk factors for coronary artery disease. The case of a young woman with unstable angina and a left main coronary artery ostial lesion on cardiac catheterization is discussed. She was subsequently diagnosed with Takayasu's arteritis 4 years later.
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Affiliation(s)
- M Jolly
- Department of Vascular Medicine, Cleveland Clinic Foundation, OH 44195, USA
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Abstract
Takayasu arteritis is usually defined as a chronic, progressive, inflammatory, occlusive disease of the aorta and its branches. However, we should remind Takayasu arteritis as a systemic disease. Here I describe nonclassical and catastrophic manifestations of the Takayasu arteritis, which often go unrecognized until after the event. Especially I stress that we should focus on cardiopulmonary complications in Takayasu arteritis.
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Affiliation(s)
- J T Lie
- Department of Pathology, University of California, Davis School of Medicine and University of California, Davis Medical Center, Sacramento 95817, USA
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Chu KH, Menapace FJ, Blankenship JC, Hausch R, Harrington T. Polyarteritis nodosa presenting as acute myocardial infarction with coronary dissection. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1998; 44:320-4. [PMID: 9676806 DOI: 10.1002/(sici)1097-0304(199807)44:3<320::aid-ccd16>3.0.co;2-o] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Coronary manifestations of polyarteritis nodosa (PAN) are rarely identified pre-mortem. We report a 51-year-old female with PAN causing a coronary dissection and new lesions developing over the next 5 days. PAN should be added to the list of differential diagnoses for spontaneous coronary dissections.
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Affiliation(s)
- K H Chu
- Department of Cardiology, Geisinger Medical Center, Penn State Geisinger Health System, Danville 17822, USA
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ODA HIROTAKA, MIIDA TSUTOMU, KIKUCHI HIROSHI, SOGA SATORU, HIGUMA NORIO, TOEDA TETSUROU, ITO EIICHI. Directional Coronary Atherectomy in Takayasu's Disease. J Interv Cardiol 1998. [DOI: 10.1111/j.1540-8183.1998.tb00108.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Jung EM, Baumann R, Rauh G, Müller-Höcker J. Unusual presentation of Takayasu arteritis with cardiac involvement and imitation of juvenile arteriosclerosis. A case report. Angiology 1996; 47:399-406. [PMID: 8619514 DOI: 10.1177/000331979604700412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A twenty-five-year-old Caucasian man with Takayasu arteritis, who was formerly diagnosed as suffering from premature arteriosclerosis, is described. Necropsy disclosed involvement of the entire aorta and its major branches, the pulmonary arteries, the coronary arteries, the intramyocardial arteries, and the heart valves, a combination hitherto not described. Literature concerning heart involvement in Takayasu arteritis is reviewed, and the differential diagnosis is discussed.
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Affiliation(s)
- E M Jung
- Institut für Pathologie and the Medizinische Poliklinik der Ludwig-Maximilians-Universität, Munich, Germany
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 4-1995. A 26-year-old woman with recurrent angina after a triple-coronary-artery bypass graft. N Engl J Med 1995; 332:380-6. [PMID: 7824001 DOI: 10.1056/nejm199502093320608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Lindström FD, Swahn E. Takayasu's arteritis as a cause of angina pectoris. J Intern Med 1993; 233:503. [PMID: 8099119 DOI: 10.1111/j.1365-2796.1993.tb01007.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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