1
|
Du Y, Ding S, Li C, Bai Y, Wang X, Li D, Xie Y, Fan G, Wu LM, Wang G. Coronary artery wall contrast enhancement imaging impact on disease activity assessment in IgG4-RD: a direct marker of coronary involvement. J Cardiovasc Magn Reson 2024; 26:101047. [PMID: 38825155 PMCID: PMC11268104 DOI: 10.1016/j.jocmr.2024.101047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/23/2024] [Accepted: 05/25/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Coronary artery wall contrast enhancement (CE) has been applied to non-invasive visualization of changes to the coronary artery wall in systemic lupus erythematosus (SLE). This study investigated the feasibility of quantifying CE to detect coronary involvement in IgG4-related disease (IgG4-RD), as well as the influence on disease activity assessment. METHODS A total of 93 subjects (31 IgG4-RD; 29 SLE; 33 controls) were recruited in the study. Coronary artery wall imaging was performed in a 3.0 T MRI scanner. Serological markers and IgG4-RD Responder Index (IgG4-RD-RI) scores were collected for correlation analysis. RESULTS Coronary wall CE was observed in 29 (94 %) IgG4-RD patients and 22 (76 %) SLE patients. Contrast-to-noise ratio (CNR) and total CE area were significantly higher in patient groups compared to controls (CNR: 6.1 ± 2.7 [IgG4-RD] v. 4.2 ± 2.3 [SLE] v. 1.9 ± 1.5 [control], P < 0.001; Total CE area: 3.0 [3.0-6.6] v. 1.7 [1.5-2.6] v. 0.3 [0.3-0.9], P < 0.001). In the IgG4-RD group, CNR and total CE area were correlated with the RI (CNR: r = 0.55, P = 0.002; total CE area: r = 0.39, P = 0.031). RI´ scored considering coronary involvement by CE, differed significantly from RI scored without consideration of CE (RI v. RI´: 15 ± 6 v. 16 ± 6, P < 0.001). CONCLUSIONS Visualization and quantification of CMR coronary CE by CNR and total CE area could be utilized to detect subclinical and clinical coronary wall involvement, which is prevalent in IgG4-RD. The potential inclusion of small and medium-sized vessel involvements in the assessment of disease activity in IgG4-RD is worthy of further investigation.
Collapse
Affiliation(s)
- Yaqi Du
- Department of Radiology, the First Hospital of China Medical University, Shenyang, China
| | - Shuang Ding
- Department of rheumatology and immunology, the First Hospital of China Medical University, Shenyang, China
| | - Ce Li
- Department of Medical Oncology, the First Hospital of China Medical University, Shenyang, China
| | - Yun Bai
- Department of Radiology, the First Hospital of China Medical University, Shenyang, China
| | - Xinrui Wang
- Department of Radiology, the First Hospital of China Medical University, Shenyang, China
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Yibin Xie
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Guoguang Fan
- Department of Radiology, the First Hospital of China Medical University, Shenyang, China.
| | - Lian-Ming Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Guan Wang
- Department of Radiology, the First Hospital of China Medical University, Shenyang, China.
| |
Collapse
|
2
|
Xing B, Liu P. Effects of staged rehabilitation training on inflammatory factor levels and red blood cell distribution width followingcardiac valve replacement. BMC Cardiovasc Disord 2024; 24:153. [PMID: 38481148 PMCID: PMC10935974 DOI: 10.1186/s12872-024-03743-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/20/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND The current study was conducted aimed atexploring the effects of staged rehabilitation training on the levels of inflammatory factors and red blood cell distribution in patients who underwent cardiac valve replacement. METHODS A total of 140 patients who underwent cardiac valve replacement at The First Hospital of Hebei Medical University between April 2021 and November 2022 were included in this study. During the postoperative rehabilitation phase, the patients were randomly assigned to either the control group or the experimental group. The experimental group received staged rehabilitation training (n = 70), while the control group received conventional care and rehabilitation suggestions without specialized staged rehabilitation training (n = 70). Informed consent was obtained from all patients prior to theirinclusion in the study. Clinical data of the patients were collected andanalyzed. RDW was measured using an automated blood cell analyzer on postoperative day 1, 14, and 28. Levels ofTNF-α, IL-6 and CRP were measured using ELISA. Quality of life was evaluated usingthe WHOQOL-BREF questionnaire. The effects of postoperative rehabilitation were assessed using the 6MWD test. The occurrence of adverse events in the postoperative periodwas alsoanalyzed. RESULTS There were no significant differences in the general characteristics of the two groups of patients (P > 0.05). On the first day after surgery, no significant differences were seen in RDW between the two groups (P > 0.05). However, on the 14th and 28th day after surgery, the experimental group exhibited a significant reduction in RDW compared to the control group (P < 0.05). On the first day after surgery, the levels of serum TNF-α, IL-6 and CRP were comparable between the two groups (P > 0.05). However, on the 14th and the 28th after surgery, the experimental group showed evidently lower levels of TNF-α, IL-6 and CRP compared to the control group (P < 0.05). The experimental group demonstrated higher scores in the domains of physical health, psychological state, social relationships, and environment in the WHOQOL-BREF questionnaire compared to the control group (P < 0.05). Furthermore, the experimental group exhibited increased average,minimum,maximum walking distances in the6-minute walking test compared to the control group (P < 0.05). There were no significant differences in the incidence of postoperative adverse events between the two groups of patients (P > 0.05). CONCLUSION Staged rehabilitation training exerteda positive effect on the levels of inflammatory factors and red blood cell distribution in patients following cardiac valve replacement. This type of rehabilitation training facilitated the patient's recovery process by reducing the inflammatory response and improving the condition of red blood cells. Additionally, it enhanced the quality of life and rehabilitation outcomes for patients.
Collapse
Affiliation(s)
- Beibei Xing
- Department of Emergency, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Pujuan Liu
- Department of Cardiac Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
| |
Collapse
|
3
|
Peng L, Li J, Zhou J, Fei Y, Dong L, Liu YY, Zhang D, Wang Y, Chi S, Wang F, Hou Y, Hong X, Sun H, Ye Y, Che N, Zhang R, Liu C, Ji Z, Sun W, Zhao C, Ma N, Lai Y, Li M, Zhao Y, Zeng X, Lu L, Zhang W. The development and initial validation of IgG4-related disease damage index: a consensus report from Chinese IgG4-RD Consortium. RMD Open 2024; 10:e003938. [PMID: 38458761 DOI: 10.1136/rmdopen-2023-003938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/15/2024] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVE To develop and conduct an initial validation of the Damage Index for IgG4-related disease (IgG4-RD DI). METHODS A draft of index items for assessing organ damages in patients with IgG4-RD was generated by experts from the Chinese IgG4-RD Consortium (CIC). The preliminary DI was refined using the Delphi method, and a final version was generated by consensus. 40 IgG4-RD cases representing four types of clinical scenarios were then selected, each with two time points of assessment for at least 3 years of follow-up. 48 rheumatologists from 35 hospitals nationwide were invited to evaluate organ damage using the CIC IgG4-RD DI. The intraclass correlation coefficient (ICC) and the Kendall-W coefficient of concordance (KW) were used to assess the inter-rater reliability. The criterion validity of IgG4-RD DI was tested by calculating the sensitivity and specificity of raters. RESULTS IgG4-RD DI is a cumulative index consisting of 14 domains of organ systems, including a total of 39 items. The IgG4-RD DI was capable of distinguishing stable and increased damage across the active disease subgroup and stable disease subgroup. In terms of scores at baseline and later observations by all raters, overall consistency in scores at baseline and later observations by all raters was satisfactory. ICC at the two time points was 0.69 and 0.70, and the KW was 0.74 and 0.73, respectively. In subgroup analysis, ICC and KW in all subgroups were over 0.55 and 0.61, respectively. The analysis of criterion validity showed a good performance with a sensitivity of 0.86 (95% CI 0.82 to 0.88), a specificity of 0.79 (95% CI 0.76 to 0.82) and an area under the curve of 0.88 (95% CI 0.85 to 0.91). CONCLUSION The IgG4-RD DI is a useful approach to analyse disease outcomes, and it has good operability and credibility. It is anticipated that the DI will become a useful tool for therapeutic trials and studies of prognosis in patients with IgG4-RD.
Collapse
Affiliation(s)
- Linyi Peng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), State Key Laboratory of Complex Severe and Rare Diseases, The Ministry of Education Key Laboratory, Beijing, China
| | - Jingna Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), State Key Laboratory of Complex Severe and Rare Diseases, The Ministry of Education Key Laboratory, Beijing, China
| | - Jiaxin Zhou
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), State Key Laboratory of Complex Severe and Rare Diseases, The Ministry of Education Key Laboratory, Beijing, China
| | - Yunyun Fei
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), State Key Laboratory of Complex Severe and Rare Diseases, The Ministry of Education Key Laboratory, Beijing, China
| | - Lingli Dong
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yan-Ying Liu
- Department of Rheumatology and Immunology, Beijing Friendship Hospital, Capital Medical University, Beijing, Beijing, China
| | - Dingding Zhang
- Medical Research Center, State Key laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanhong Wang
- Department of Epidemiology and Bio-statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Shuhong Chi
- Department of Rheumatology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Fang Wang
- Department of Rheumatology, Beijing Hospital, Beijing, China
| | - Yunxia Hou
- Department of Rheumatology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Xiaoping Hong
- Department of Rheumatology and Immunology, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Hongsheng Sun
- Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yujin Ye
- Department of Rheumatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Nan Che
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Rong Zhang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Changyan Liu
- Department of Rheumatology, the Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zongfei Ji
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenjia Sun
- Department of Rheumatology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Cheng Zhao
- Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, Jiangsu, China
| | - Ning Ma
- Department of Rheumatology, The First Hospital of Jilin University, Changchun, China
| | - Yamin Lai
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), State Key Laboratory of Complex Severe and Rare Diseases, The Ministry of Education Key Laboratory, Beijing, China
| | - Yan Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), State Key Laboratory of Complex Severe and Rare Diseases, The Ministry of Education Key Laboratory, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), State Key Laboratory of Complex Severe and Rare Diseases, The Ministry of Education Key Laboratory, Beijing, China
| | - Liwei Lu
- Department of Pathology and Shenzhen Institute of Research and Innovation, The University of Hong Kong, Hong Kong, China
| | - Wen Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), State Key Laboratory of Complex Severe and Rare Diseases, The Ministry of Education Key Laboratory, Beijing, China
| |
Collapse
|
4
|
Tsuneta S, Suno K, Fujieda Y, Watanabe M, Watanabe S, Hirata K, Nagai T, Kudo K. Accumulation of Technetium-99m Tetrofosmin on Myocardial Perfusion Scintigraphy in a Patient With Immunoglobulin G4-Related Coronary Periarteritis. Can J Cardiol 2024; 40:450-451. [PMID: 38787748 DOI: 10.1016/j.cjca.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/23/2023] [Accepted: 10/23/2023] [Indexed: 05/26/2024] Open
Affiliation(s)
- Satonori Tsuneta
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan.
| | - Kenichiro Suno
- Department of Cardiovascular Surgery, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Yuichiro Fujieda
- Department of Rheumatology, Endocrinology, and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaya Watanabe
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shiro Watanabe
- Department of Diagnostic Imaging, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kenji Hirata
- Department of Diagnostic Imaging, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kohsuke Kudo
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan; Department of Diagnostic Imaging, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| |
Collapse
|
5
|
Showkathali R, Yalamanchi RP, Kumar AM, Cs V. Isolated Giant Right Coronary Aneurysm Associated With IgG4-Related Disease. Can J Cardiol 2024; 40:447-449. [PMID: 37806548 DOI: 10.1016/j.cjca.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/23/2023] [Accepted: 10/01/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- Refai Showkathali
- Department of Cardiology and Cardiothoracic Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | - Radha Priya Yalamanchi
- Department of Cardiology and Cardiothoracic Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India.
| | - Aishwarya Mahesh Kumar
- Department of Cardiology and Cardiothoracic Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | - Vijayshankar Cs
- Department of Cardiology and Cardiothoracic Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
| |
Collapse
|
6
|
Sugawara H, Takahashi T, Kimura Y, Matsui A, Matsumoto T, Nishisato K, Nishimura M. IgG4-Related Pericarditis Diagnosed by Accumulated Pericardial Effusion. Case Rep Cardiol 2023; 2023:9223342. [PMID: 38045861 PMCID: PMC10691889 DOI: 10.1155/2023/9223342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 12/05/2023] Open
Abstract
IgG4-related pericarditis has rarely been reported. Here, we report a case of IgG4-related disease that presented with pericardial effusion. A 67-year-old female who presented with palpitations and chest pain was admitted because of a large amount of pericardial effusion that required drainage. The patient underwent pericardial drainage, and the symptoms were gradually alleviated. IgG4 levels were elevated in the serum and pericardial effusions. A biopsy specimen of 18F-FDG accumulated in the submandibular gland showed lymphocyte infiltration with IgG4-positive cells. The patient was diagnosed with IgG4-related pericarditis. Glucocorticoids resolved serological and imaging abnormalities. Prompt treatment improves the disease status.
Collapse
Affiliation(s)
- Hirohito Sugawara
- Department of Cardiology, Tenshi Hospital, 1-1 North-12 East-3, Higashi-ku, Sapporo, Hokkaido, Japan 0658611
- Division of Nephrology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, 35-1, Chigasakichuo, Tsuzuki-ku, Yokohama, Japan 2248503
| | - Tomokazu Takahashi
- Department of Cardiology, Tenshi Hospital, 1-1 North-12 East-3, Higashi-ku, Sapporo, Hokkaido, Japan 0658611
| | - Yukishige Kimura
- Department of Cardiology, Tenshi Hospital, 1-1 North-12 East-3, Higashi-ku, Sapporo, Hokkaido, Japan 0658611
| | - Azumi Matsui
- Department of Cardiology, Tenshi Hospital, 1-1 North-12 East-3, Higashi-ku, Sapporo, Hokkaido, Japan 0658611
| | - Tamaki Matsumoto
- Department of Cardiology, Tenshi Hospital, 1-1 North-12 East-3, Higashi-ku, Sapporo, Hokkaido, Japan 0658611
| | - Kimio Nishisato
- Department of Cardiology, Tenshi Hospital, 1-1 North-12 East-3, Higashi-ku, Sapporo, Hokkaido, Japan 0658611
| | - Mitsuhiro Nishimura
- Department of Cardiology, Tenshi Hospital, 1-1 North-12 East-3, Higashi-ku, Sapporo, Hokkaido, Japan 0658611
| |
Collapse
|
7
|
Soh BWT, Prendergast SC, Burke L, O’Connor CT, Ullah I, O’Brien JM, Hinchion JA, Arnous S, Kiernan TJ. Severe Aortic Valvular Incompetence From IgG4-Related Disease: An Unusual Entity. JACC Case Rep 2023; 24:102027. [PMID: 37869216 PMCID: PMC10589445 DOI: 10.1016/j.jaccas.2023.102027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/07/2023] [Accepted: 08/25/2023] [Indexed: 10/24/2023]
Abstract
IgG4-related disease (IgG4-RD) is a new clinical entity characterized by lymphoplasmacytic lesions rich in IgG4-positive plasma cells. Myocardial involvement is extremely rare and not a typical cardiovascular manifestation of IgG4-RD. We report a rare case of IgG4-RD-associated myocardial mass causing severe aortic incompetence, successfully treated with surgery and corticosteroids. (Level of Difficulty: Intermediate.).
Collapse
Affiliation(s)
| | | | - Louise Burke
- Department of Histopathology, Cork University Hospital, Cork, Ireland
| | - Cormac T. O’Connor
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Ihsan Ullah
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Julie M. O’Brien
- Department of Radiology, University Hospital Limerick, Limerick, Ireland
| | - John A. Hinchion
- Department of Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland
| | - Samer Arnous
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Thomas J. Kiernan
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
| |
Collapse
|
8
|
Carsote M, Nistor C. Reshaping the Concept of Riedel's Thyroiditis into the Larger Frame of IgG4-Related Disease (Spectrum of IgG4-Related Thyroid Disease). Biomedicines 2023; 11:1691. [PMID: 37371786 DOI: 10.3390/biomedicines11061691] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Recently, Riedel's thyroiditis (RT) was assimilated into the larger spectrum of immunoglobulin IgG4-related disease (IgG4-RD) in addition to a particular frame of IgG4-related thyroid disease (IgG4-RTD), underlying IgG4-RT, IgG4-associated Hashimoto's thyroiditis (and its fibrotic variant), and IgG4-related Graves's disease. Our objective was to overview recent data on RT, particularly IgG4-RD and IgG4-RTD. The case and study- sample analysis (2019-2023) included 293 articles and selected 18 original studies: nine single case reports (N = 9, female/male = 2/1, aged: 34-79 years, 5/9 patients with serum IgG4 available data, 2/5 with high serum IgG4) and four case series (N = 21; 4/5 series provided data on IgG4 profile, 3/21 had serum IgG4 assays, and 2/3 had abnormally high values). IgG4-RD and thyroid findings were analyzed in three cohorts (N = 25). Another two studies (N = 11) specifically addressed IgG4-RTD components. On presentation, the patients may have hypothyroidism, transitory thyrotoxicosis, goiter, long-term history of positive anti-thyroid antibodies, and hypoechoic ultrasound thyroid pattern. The 5-year analysis (N = 66) showed the rate of serum IgG4 evaluation remained low; normal values do not exclude RT. Mandatory histological and immunohistochemistry reports point out a high content of IgG4-carrying plasma cells and IgG4/IgG ratio. Unless clinically evident, histological confirmation provides a prompt indication of starting corticoid therapy since this is the first-line option. Surgery, if feasible, is selective (non-responders to medical therapy, emergency tracheal intervention, and open/core needle biopsy). Current open issues are identifying the role of serum IgG4 assays in patients with IgG4-RD, finding out if all cases of RT are IgG4-mediated, applying IgG4-RTD criteria of differentiation among four entities, and providing an RT/IgG4-RTD guideline from diagnosis to therapy. It remains that the central aim of approaching RT in daily practice is the early index of suspicion in order to select patients referred for further procedures that provide enough histological/immunohistochemistry material to confirm RT and its high IgG4 burden.
Collapse
Affiliation(s)
- Mara Carsote
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy & C.I. Parhon National Institute of Endocrinology, 011863 Bucharest, Romania
| | - Claudiu Nistor
- Department 4-Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, Carol Davila University of Medicine and Pharmacy & Thoracic Surgery Department, Dr. Carol Davila Central Emergency University Military Hospital, 050474 Bucharest, Romania
| |
Collapse
|
9
|
Yagi H, Amiya E, Uehara M, Minatsuki S, Hatano M, Takeda N, Akazawa H, Komuro I. Coronary periarteritis and pericardial thickening could be predictors for coronary artery events complicated by immunoglobulin G4-related disease. CJC Open 2023. [DOI: 10.1016/j.cjco.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
|
10
|
Duarte-Millán MÁ, Bernal-Bello D, Frutos-Pérez B, Canora-Lebrato J. Point-of-care ultrasonography in large vessel involvement by IgG4-related disease: an opportunity for monitoring? Rheumatology (Oxford) 2023; 62:e30-e31. [PMID: 35861403 DOI: 10.1093/rheumatology/keac420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
| | - David Bernal-Bello
- Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Begoña Frutos-Pérez
- Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Jesús Canora-Lebrato
- Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain
| |
Collapse
|
11
|
Cochran RL, Brideau HR, Wu MY, Stone JH, Wallace ZS, Little BP. Pulmonary and coronary arterial abnormalities in patients with IgG4-related disease. Radiol Case Rep 2022; 17:4924-4927. [PMID: 36299866 PMCID: PMC9589001 DOI: 10.1016/j.radcr.2022.09.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/18/2022] [Accepted: 09/21/2022] [Indexed: 01/24/2023] Open
Abstract
IgG4-related disease (IgG4-RD) is an immune-mediated multiorgan fibroinflammatory disorder with variable clinical presentations. IgG4-RD cardiovascular involvement is considered rare, with pulmonary arterial involvement reported in a small subset of cases. Known pulmonary artery manifestations include pulmonary arteritis, pulmonary artery stenoses and central pulmonary artery aneurysms. Here we report 2 different patients with multifocal dilatation of the segmental and subsegmental pulmonary arteries with differing degrees of severity. Both patients also had coronary arterial abnormalities.
Collapse
Affiliation(s)
- Rory L. Cochran
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA
| | - Holly R. Brideau
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA
| | - Markus Y. Wu
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA
| | - John H. Stone
- Division of Rheumatology, Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA
| | - Zachary S. Wallace
- Division of Rheumatology, Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA
| | - Brent P. Little
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA,Department of Radiology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224, USA,Corresponding author.
| |
Collapse
|
12
|
Maltês S, Cabral M, Freitas P, Albuquerque C, Fernandes C, Moura D, Santos B, Mendes M, Neves J. Immunoglobulin G4-related constrictive pericarditis and the importance of a thorough workup: a case report. BMC Cardiovasc Disord 2022; 22:28. [PMID: 35120437 PMCID: PMC8815176 DOI: 10.1186/s12872-022-02468-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 01/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Constrictive pericarditis remains a problematic diagnosis and a thorough investigation is critical. Among possible aetiologies, immunoglobulin-G4 (IgG4)-related pericardial disease is an unusual cause of pericardial constriction. We report a challenging diagnostic case of pericardial constriction due to IgG4-related disease. Case presentation A 68-year old male with a history of inferior myocardial infarction with right ventricle (RV) involvement was thrice-hospitalized due to marked ascites and peripheral oedema. Systemic congestion was initially attributed to RV dysfunction due to previous infarction. Yet, at the final admission, a re-assessment echocardiogram followed by cardiac computed tomography, magnetic resonance and right heart catheterization raised a possible diagnosis of constrictive pericarditis with a finding of abnormal pulmonary venous return. Patient therefore underwent pericardiectomy and surgical correction of pulmonary venous return. Pericardium histology revealed an IgG4-related pericardial constriction. Patient was later discharged on corticosteroids with marked symptomatic improvement. Conclusion IgG4-related disease remains a rare cause of pericardium constriction while also presenting a challenging diagnosis in everyday clinical practice. This case exemplifies the difficulties faced by clinicians when reviewing a possible case of constrictive pericarditis, while highlighting the importance of a multimodality assessment. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02468-1.
Collapse
Affiliation(s)
- Sérgio Maltês
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Lisbon, Portugal.
| | | | - Pedro Freitas
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Lisbon, Portugal
| | - Catarina Albuquerque
- Anatomical Pathology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | | | - Diana Moura
- Internal Medicine Department, Hospital Leiria, Leiria, Portugal
| | - Beatriz Santos
- Cardiology Department, Hospital Leiria, Leiria, Portugal
| | - Miguel Mendes
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Lisbon, Portugal
| | - José Neves
- Cardiothoracic Surgery Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| |
Collapse
|
13
|
Elevated cytokines and chemokines in peripheral blood of patients with SARS-CoV-2 pneumonia treated with high-titer convalescent plasma. PLoS Pathog 2021; 17:e1010025. [PMID: 34714894 PMCID: PMC8580259 DOI: 10.1371/journal.ppat.1010025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/10/2021] [Accepted: 10/11/2021] [Indexed: 12/28/2022] Open
Abstract
The global SARS-CoV-2 coronavirus pandemic continues to be devastating in many areas. Treatment options have been limited and convalescent donor plasma has been used by many centers to transfer passive neutralizing antibodies to patients with respiratory involvement. The results often vary by institution and are complicated by the nature and quality of the donor plasma itself, the timing of administration and the clinical aspects of the recipients. SARS-CoV-2 infection is known to be associated with an increase in the blood concentrations of several inflammatory cytokines/chemokines, as part of the overall immune response to the virus and consequential to mediated lung pathology. Some of these correlates contribute to the cytokine storm syndrome and acute respiratory distress syndrome, often resulting in fatality. A Phase IIa clinical trial at our institution using high neutralizing titer convalescent plasma transfer gave us the unique opportunity to study the elevations of correlates in the first 10 days after infusion. Plasma recipients were divided into hospitalized COVID-19 pneumonia patients who did not (Track 2) or did (Track 3) require mechanical ventilation. Several cytokines were elevated in the patients of each Track and some continued to rise through Day 10, while others initially increased and then subsided. Furthermore, elevations in MIP-1α, MIP-1β and CRP correlated with disease progression of Track 2 recipients. Overall, our observations serve as a foundation for further study of these correlates and the identification of potential biomarkers to improve upon convalescent plasma therapy and to drive more successful patient outcomes. COVID-19, the disease caused by the SARS-CoV-2 virus, has a varied clinical course with limited treatment options. While some patients mount a productive immune response leading to recovery, others progress to rapid respiratory deterioration that may require hospitalization and mechanical ventilation. Our institution conducted a clinical trial to evaluate the efficacy of convalescent plasma therapy (CPT) to treat patients hospitalized with COVID-19 pneumonia. In this arm of the study, we sought to examine immune analytes in donor plasma as well as evaluate the recipients’ plasma before CPT infusion, and at Day 3 and Day 10 post-CPT infusion. We found some analytes to be elevated in plasma donors, compared to healthy controls, even after recovery. Plasma composition in CPT recipients prior to infusion showed elevations in several analytes associated with immune activation. Some significant differences were seen in plasma composition in patients in our Track 2 cohort (hospitalized without mechanical ventilation) compared to the Track 3 cohort (hospitalized with mechanical ventilation). In addition, we obtained plasma samples for hospitalized COVID-19 patients that did not receive CPT and noted several differences in the course of immune analyte production over time compared to the CPT-treated patients.
Collapse
|
14
|
Iraola D, Marcos-Garcés V, García Blas S, Sanchis J, Bahamonde JÁ, Gracia JM, Forner MJ, Rojo N, Chorro FJ, López FJ. Immunoglobulin G4-related aortitis and severe aortic valve stenosis treated with transcatheter aortic valve replacement and immunosuppression. Can J Cardiol 2021; 37:1873-1876. [PMID: 34333027 DOI: 10.1016/j.cjca.2021.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/15/2021] [Accepted: 07/23/2021] [Indexed: 11/19/2022] Open
Abstract
IgG4-related disease is an immune-mediated fibro-inflammatory disorder with multisystemic involvement. Aortitis and periaortitis are the most common cardiovascular manifestations of the disease. We present the case of a 65-year-old male with symptomatic severe aortic stenosis and concomitant IgG4 aortitis. The diagnosis was confirmed by IgG4 serum levels, positive PET-TC, and pathology from mediastinal dissection. Surgical aortic valve replacement (SAVR) was unfeasible due to extensive mediastinal fibrosis, and transcatheter aortic valve replacement (TAVR) was successfully performed. Since ascending aorta access for SAVR in IgG4 aortitis with long-run fibrosis entails a high mortality risk, TAVR could be considered in certain suitable patients.
Collapse
Affiliation(s)
- Diego Iraola
- Department of Cardiology, Hospital Clinico Universaitario de Valencia, Valencia, Spain.
| | - Víctor Marcos-Garcés
- Department of Cardiology, Hospital Clinico Universaitario de Valencia, Valencia, Spain; INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Sergio García Blas
- Department of Cardiology, Hospital Clinico Universaitario de Valencia, Valencia, Spain; INCLIVA Biomedical Research Institute, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Juan Sanchis
- Department of Cardiology, Hospital Clinico Universaitario de Valencia, Valencia, Spain; INCLIVA Biomedical Research Institute, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Faculty of Medicine, University of Valencia, Valencia, Spain
| | - José Ángel Bahamonde
- Department of Cardiac Surgery, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Juan Manuel Gracia
- Department of Cardiac Surgery, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - María José Forner
- INCLIVA Biomedical Research Institute, Valencia, Spain; Faculty of Medicine, University of Valencia, Valencia, Spain; Department of Internal Medicine, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Natalia Rojo
- Department of Pathology, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Francisco Javier Chorro
- Department of Cardiology, Hospital Clinico Universaitario de Valencia, Valencia, Spain; INCLIVA Biomedical Research Institute, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Francisco Jesús López
- Department of Cardiology, Hospital Clinico Universaitario de Valencia, Valencia, Spain
| |
Collapse
|
15
|
Gori T. Coronary Vasculitis. Biomedicines 2021; 9:biomedicines9060622. [PMID: 34072772 PMCID: PMC8226826 DOI: 10.3390/biomedicines9060622] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/23/2021] [Accepted: 05/28/2021] [Indexed: 02/06/2023] Open
Abstract
The term coronary “artery vasculitis” is used for a diverse group of diseases with a wide spectrum of manifestations and severity. Clinical manifestations may include pericarditis or myocarditis due to involvement of the coronary microvasculature, stenosis, aneurysm, or spontaneous dissection of large coronaries, or vascular thrombosis. As compared to common atherosclerosis, patients with coronary artery vasculitis are younger and often have a more rapid disease progression. Several clinical entities have been associated with coronary artery vasculitis, including Kawasaki’s disease, Takayasu’s arteritis, polyarteritis nodosa, ANCA-associated vasculitis, giant-cell arteritis, and more recently a Kawasaki-like syndrome associated with SARS-COV-2 infection. This review will provide a short description of these conditions, their diagnosis and therapy for use by the practicing cardiologist.
Collapse
Affiliation(s)
- Tommaso Gori
- Kardiologie I and DZHK Standort Rhein-Main, Universitätsmedizin Mainz, 55131 Mainz, Germany
| |
Collapse
|