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Qavi AH, Ahmad S, Shah NN, Shammas R. Rare Manifestation of COVID-19 Resulting in Coronary Artery Vasculitis. Case Rep Cardiol 2024; 2024:8976833. [PMID: 38322171 PMCID: PMC10846917 DOI: 10.1155/2024/8976833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/06/2024] [Accepted: 01/11/2024] [Indexed: 02/08/2024] Open
Abstract
We present the case of a 59-year-old African American female with end-stage renal disease (ESRD) who presented to the emergency department with chest discomfort. She had a coronary angiogram six months ago that showed no occlusive epicardial coronary artery disease. She had elevated troponin I levels and new regional wall motion abnormalities on echocardiogram. Her SARS-CoV-2 returned positive. After a multidisciplinary team approach, she underwent another coronary angiogram that showed new severe multivessel ostial lesions and a left main coronary artery aneurysm. COVID-19-related coronary artery vasculitis was suspected based on her clinical presentation, angiogram findings, and negative autoimmune workup. The patient underwent successful coronary artery bypass grafting and recovered without complications.
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Affiliation(s)
- Ahmed Hassaan Qavi
- Department of Cardiovascular Sciences, East Carolina University Health Medical Center, Greenville, NC, USA
| | - Soban Ahmad
- Department of Cardiovascular Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Neeraj N. Shah
- Department of Cardiovascular Sciences, East Carolina University Health Medical Center, Greenville, NC, USA
| | - Rony Shammas
- Department of Cardiovascular Sciences, East Carolina University Health Medical Center, Greenville, NC, USA
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2
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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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3
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Sierra-Galan LM, Bhatia M, Alberto-Delgado AL, Madrazo-Shiordia J, Salcido C, Santoyo B, Martinez E, Soto ME. Cardiac Magnetic Resonance in Rheumatology to Detect Cardiac Involvement Since Early and Pre-clinical Stages of the Autoimmune Diseases: A Narrative Review. Front Cardiovasc Med 2022; 9:870200. [PMID: 35911548 PMCID: PMC9326004 DOI: 10.3389/fcvm.2022.870200] [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: 02/06/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Autoimmune diseases (ADs) encompass multisystem disorders, and cardiovascular involvement is a well-known feature of autoimmune and inflammatory rheumatic conditions. Unfortunately, subclinical and early cardiovascular involvement remains clinically silent and often undetected, despite its well-documented impact on patient management and prognostication with an even more significant effect on severe and future MACE events as the disease progresses. Cardiac magnetic resonance imaging (MRI), today, commands a unique position of supremacy versus its competition in cardiac assessment and is the gold standard for the non-invasive evaluation of cardiac function, structure, morphology, tissue characterization, and flow with the capability of evaluating biventricular function; myocardium for edema, ischemia, fibrosis, infarction; valves for thickening, large masses; pericardial inflammation, pericardial effusions, and tamponade; cardiac cavities for thrombosis; conduction related abnormalities and features of microvascular and large vessel involvement. As precise and early detection of cardiovascular involvement plays a critical role in improving the outcome of rheumatic and autoimmune conditions, our review aims to highlight the evolving role of CMR in systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), rheumatoid arthritis (RA), systemic sclerosis (SSc), limited sclerosis (LSc), adult-onset Still's disease (AOSD), polymyositis (PM), dermatomyositis (DM), eosinophilic granulomatosis with polyangiitis (EGPA) (formerly Churg-Strauss syndrome), and DRESS syndrome (DS). It draws attention to the need for concerted, systematic global interdisciplinary research to improve future outcomes in autoimmune-related rheumatic conditions with multiorgan, multisystem, and cardiovascular involvement.
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Affiliation(s)
- Lilia M. Sierra-Galan
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
| | - Mona Bhatia
- Department of Imaging, Fortis Escorts Heart Institute, New Delhi, India
| | | | - Javier Madrazo-Shiordia
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
| | - Carlos Salcido
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
| | - Bernardo Santoyo
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
| | - Eduardo Martinez
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
| | - Maria Elena Soto
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
- Immunology Department of the National Institute of Cardiology, “Ignacio Chavez”, Mexico City, Mexico
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4
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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.
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Affiliation(s)
- Tommaso Gori
- Kardiologie I and DZHK Standort Rhein-Main, Universitätsmedizin Mainz, 55131 Mainz, Germany
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Khanna S, Garikapati K, Goh DSL, Cho K, Lo P, Bhojaraja MV, Tarafdar S. Coronary artery vasculitis: a review of current literature. BMC Cardiovasc Disord 2021; 21:7. [PMID: 33407141 PMCID: PMC7788693 DOI: 10.1186/s12872-020-01813-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022] Open
Abstract
Cardiac vasculitis is recognized as a heterogeneous disease process with a wide spectrum of manifestations including pericarditis, myocarditis, valvular heart disease and less frequently, coronary artery vasculitis (CAV). CAV encompasses an emerging field of diseases which differ from conventional atherosclerotic disease and have a proclivity for the younger population groups. CAV portends multiple complications including the development of coronary artery aneurysms, coronary stenotic lesions, and thrombosis, all which may result in acute coronary syndromes. There are several aetiologies for CAV; with Kawasaki's disease, Takayasu's arteritis, Polyarteritis Nodosa, and Giant-Cell Arteritis more frequently described clinically, and in literature. There is a growing role for multi-modality imaging in assisting the diagnostic process; including transthoracic echocardiography, cardiac magnetic resonance imaging, computed tomography coronary angiography, fluorodeoxyglucose-positron emission tomography and conventional coronary angiogram with intravascular ultrasound. Whilst the treatment paradigms fundamentally vary between different aetiologies, there are overlaps with pharmacological regimes in immunosuppressive agents and anti-platelet therapies. Interventional and surgical management are is a consideration in select populations groups, within a multi-disciplinary context. Further large-scale studies are required to better appropriately outline management protocols in this niche population.
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Affiliation(s)
- Shaun Khanna
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia.
| | - Kartheek Garikapati
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | - Daniel S L Goh
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | - Kenneth Cho
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | - Phillip Lo
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | | | - Surjit Tarafdar
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia.,Faculty of Medicine, Western Sydney University, Sydney, NSW, Australia
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Abstract
Als Perikarditis wird eine Entzündung des Herzbeutels bezeichnet, die mit einem Perikarderguss oder einer entzündlichen Reaktion des Myokards (Perimyokarditis) einhergehen kann. Die Perikarditis kann im Rahmen von entzündlich rheumatischen Systemerkrankungen oder als eigenständige Erkrankung vorkommen. Rezidivierende Perikarditisepisoden ohne fassbare Ursache werden als idiopathische rekurrierende Perikarditis (IRP) bezeichnet, welche wesentliche Gemeinsamkeiten mit autoinflammatorischen Erkrankungen aufweist. Der Artikel gibt einen Überblick über die Häufigkeit des Auftretens einer Perikarditis bei rheumatologischen Erkrankungen. Weiterhin werden Klinik und Pathophysiologie der IRP diskutiert. Abschließend wird die Therapie der akuten und idiopathischen Perikarditis erläutert.
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Pericardial Tamponade: An Uncommon Clinical Presentation in cANCA Related Vasculitis and Glomerulonephritis in Association with Very High Titres of ANA. Case Rep Nephrol 2019; 2019:4983139. [PMID: 31312533 PMCID: PMC6595352 DOI: 10.1155/2019/4983139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 05/12/2019] [Accepted: 05/19/2019] [Indexed: 11/18/2022] Open
Abstract
ANCA (anti-neutrophil cytoplasmic antibody) vasculitides are systemic autoimmune diseases in which anti-neutrophilic cytoplasmic antibodies activate primed neutrophils, thereby generating an inflammatory cascade resulting in the damage of small sized blood vessels in various organs of the body, including the heart. Pleuropericardial involvement is underrecognized as a complication of ANCA vasculitis and is highlighted in this case report of a 51-year-old male who presented with an initial symptomatic presentation of pleuropericardial effusion progressing to pericardial tamponade in the setting of a later renal biopsy proven pauci-immune crescentic glomerulonephritis with high ANA titres along with positive cANCA (cytoplasmic ANCA) and PR3 (proteinase 3) antibodies. He was found to have acute renal failure which progressively got better with cyclophosphamide.
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8
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Braun J, Krüger K, Manger B, Schneider M, Specker C, Trappe HJ. Cardiovascular Comorbidity in Inflammatory Rheumatological Conditions. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:197-203. [PMID: 28407841 DOI: 10.3238/arztebl.2017.0197] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 05/03/2016] [Accepted: 01/18/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Approximately 1.5 million adults in Germany suffer from an inflammatory rheumatological condition. The most common among these are rheumatoid arthritis and spondyloarthritis-above all axial spondyloarthritis, including ankylosing spondylitis (Bekhterev's disease) and psoriatic arthritis. These systemic inflammatory diseases often affect the heart as well. METHODS This review is based on pertinent articles retrieved by a selective literature search, on current European guidelines, and on the authors' clinical experience. RESULTS Rheumatic inflammation of cardiac structures can manifest itself as pericarditis, myocarditis, or endocarditis. The heart valves and the intracardiac conduction system can be affected as well, leading to AV block. Functional sequelae, e.g., congestive heart failure, can arise as a consequence of any inflammatory rheumatic disease. The long-term mortality of rheumatic diseases is elevated predominantly because of the increased risk for cardiovascular comorbidities. The cardiovascular risk profile should therefore be re-evaluated regularly (e.g., at 5-year intervals) in cooperation with the patient's primary care physician. The cardiovascular manifestations of rheumatic disease, such as pericarditis, myocarditis, and vasculitis, are treated initially with high-dose glucocorticoids and then over the long term with maintenance drugs such as methotrexate and azathioprine. Biological agents are sometimes used as well. CONCLUSION In patients with inflammatory rheumatic diseases, the elevated cardiovascular risk should be kept in mind and preventive measures should be initiated early. This subject should be further studied in controlled trials so that the treatment options for patients with cardiac involvement can be evaluated.
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Affiliation(s)
- Jürgen Braun
- Rheumazentrum Ruhrgebiet, Herne; Rheumazentrum München, Munich; Department of Medicine 3, Universitätsklinikum Erlangen; Department of Rheumatology, Hiller Research Center Rheumatology, University Hospital Düsseldorf; Department of Rheumatology and Clinical Immunology, St. Josef Krankenhaus, Essen University Hospital; Department of Cardiology, Marien-Hospital Herne, University Hospitals of the Ruhr University of Bochum
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9
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Broncano J, Vargas D, Bhalla S, Cummings KW, Raptis CA, Luna A. CT and MR Imaging of Cardiothoracic Vasculitis. Radiographics 2018; 38:997-1021. [PMID: 29883266 DOI: 10.1148/rg.2018170136] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The term vasculitis includes a variable group of entities in which the common characteristic is inflammation of the walls of blood vessels occurring at some time during the course of the disease. The vasculitides can be divided into primary and secondary vasculitides, depending on the etiology and according to the size of the vessel affected. Both primary vasculitis and secondary vasculitis are associated with cardiac morbidity that is often subclinical. Cardiac involvement is associated with prognostic implications and higher rates of related mortality. Vasculitis of cardiac structures and the assessment of disease extent are important for appropriate management and selection of treatment. Although echocardiography, radionuclide imaging, and catheter-directed coronary angiography remain the cornerstones of cardiac imaging, cardiac computed tomography and magnetic resonance imaging can offer a 360° assessment of cardiac anatomy, function, and complications secondary to vasculitis. Postoperative complications, which are more frequent in patients with active disease, can also be depicted with those imaging modalities. A multidisciplinary approach is important to yield an appropriate estimate of the disease activity and extent and, therefore, to enable better treatment selection and monitoring. Online supplemental material is available for this article. ©RSNA, 2018.
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Affiliation(s)
- Jordi Broncano
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
| | - Daniel Vargas
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
| | - Sanjeev Bhalla
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
| | - Kristopher W Cummings
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
| | - Constantine A Raptis
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
| | - Antonio Luna
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
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Matsuda S, Yoshida S, Fujiki Y, Satomi H, Takeuchi T, Hirose Y, Makino S, Arawaka S. Eosinophilic granulomatosis with polyangiitis complicated by subarachnoid hemorrhage and coronary vasculitis: a case report and review of the literature. Rheumatol Int 2017; 38:689-696. [PMID: 29127573 DOI: 10.1007/s00296-017-3875-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/03/2017] [Indexed: 02/03/2023]
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is characterized by necrotizing vasculitis of small-sized vessels with extravascular granulomas and eosinophilic infiltration. The case of a 48-year-old Japanese woman with EGPA, who presented concurrently with subarachnoid hemorrhage (SAH) and coronary vasculitis, is reported. She initially presented with bronchial asthma, and then 8 months later she developed various symptoms caused by systemic eosinophilic vasculitis and was admitted to our hospital. Three days after admission, she started oral corticosteroid therapy, and her 2009 Five-Factor Score (FFS) was 0. However, she developed an SAH, followed by coronary vasculitis 1 day later. With extensive treatment with a combination of betamethasone, cyclophosphamide, intravenous immunoglobulin, and rituximab, her systemic vasculitis improved dramatically. This seems to be the first case of EGPA with SAH and coronary vasculitis. In previous reports of EGPA with SAH, 4 of 11 cases developed SAH as an exacerbation of systemic vasculitis during remission induction therapy. The present patient also had SAH during remission induction therapy. However, the period between bronchial asthma and SAH was only 8 months. This is the shortest among case reports of EGPA with SAH. In addition, the present patient rapidly developed coronary vasculitis. These findings suggest that EGPA causes SAH and coronary vasculitis as early complications of systemic vasculitis. In EGPA, it is necessary to pay careful attention to rapid changes of disease activity, even when the FFS indicates a good prognosis.
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Affiliation(s)
- Shogo Matsuda
- Department of Internal Medicine (IV), Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Shuzo Yoshida
- Department of Internal Medicine (IV), Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Youhei Fujiki
- Department of Internal Medicine (IV), Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Hidetoshi Satomi
- Department of Internal Medicine (IV), Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Tohru Takeuchi
- Department of Internal Medicine (IV), Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Yoshinobu Hirose
- Department of Internal Medicine (IV), Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Shigeki Makino
- Department of Internal Medicine (IV), Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Shigeki Arawaka
- Department of Internal Medicine (IV), Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
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11
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Ventricular fibrillation in rheumatoid arthritis. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2016.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Schiefermueller J, Alaour B, Calver A, Curzen N. Lesson of the month 1: Beware the atypical presentation: eosinophilic granulomatosis with polyangiitis presenting as acute coronary syndrome. Clin Med (Lond) 2017; 17:180-182. [PMID: 28365634 PMCID: PMC6297632 DOI: 10.7861/clinmedicine.17-2-180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We describe the case of a 45-year-old woman presenting with troponin positive cardiac-sounding chest pain. An initial emergency angiogram demonstrated two vessel coronary disease, including a distal right coronary artery occlusion. No percutaneous coronary intervention was performed and the patient was treated medically. At re-presentation with further pain a few days later, coronary angiography demonstrated no significant coronary lesions. After consideration of other multisystem symptoms and raised eosinophil count, the patient was diagnosed with eosinophilic granulomatosis with polyangiitis (formerly known as Churg-Strauss syndrome) presenting with coronary arteritis. This case should remind physicians to be vigilant and to consider non-atherosclerotic causes of acute coronary syndrome presentation, which should not always result in a stent.
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Affiliation(s)
| | | | | | - Nick Curzen
- University Hospital Southampton, Southampton, UK
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13
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Francis W, Aziz Eid Al Kuwari MA, Ghareep AN, Peyrou J, Szmigielski W. A Rare Right Ventricular Involvement of Eosinophilic Granulomatosis Demonstrated by Cardiac MRI. Pol J Radiol 2017; 81:598-601. [PMID: 28058073 PMCID: PMC5181521 DOI: 10.12659/pjr.898964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 05/10/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis with a prevalence rate of seven per million. Cardiac involvement was reported in 20-50%, yet with improved diagnostic methods, the frequency of cardiac involvement is expected to be even higher. It can result in significant morbidity and mortality, accounting for about 50% of death. Cardiac magnetic resonance (CMR) imaging is used to evaluate the myocardium, valves, coronary arteries, pericardium, also to assess cardiac structure and function. Perfusion study allows tissue characterisation with a suggestive pattern of late gadolinium enhancement. CASE REPORT We report a rare case of EGPA in a 54-year-old male patient who presented with fever, sore throat and dizziness. Echocardiography showed a filling defect at the apex of the right ventricle (RV). CMR findings suggested the diagnosis of EGPA by demonstrating an impressive lesion at RV apex with the typical 3-layer appearance and thrombus formation. Post-gadolinium subendocardial hyperenhancement suggested focal involvement at the inferolateral wall of the left ventricle. Computed Tomography (CT) was done to rule out calcific or soft plaques of the coronary arteries, small vessel vasculitis and small aneurysm. CT scan showed a low-attenuation lesion at the inner wall of the right ventricle. In the lungs, bilateral interstitial changes and bilateral cystic bronchiectases were found. Under appropriate treatment, the patient improved clinically. CONCLUSIONS It is of crucial importance to perform full cardiac imaging that includes CMR even in asymptomatic patients with suspected EGPA, since early identification of cardiac involvement may allow to apply appropriate therapy and full recovery of the patient.
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Affiliation(s)
- Willington Francis
- Department of Clinical Imaging, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Abdel-Naser Ghareep
- Department of Clinical Imaging, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Jérôme Peyrou
- Department of Cardiac Imaging, Bordeaux University Hospital, Haut-Lévêque Heart Hospital, Pessac, France
| | - Wojciech Szmigielski
- Department of Clinical Imaging, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
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Lin CY, Hsu CY, Huang PH. Rapid Resolution of Severe Myocardial Dysfunction in a Patient with Rheumatoid Arthritis by Intravenous Immunoglobulin and Steroid Treatment. ACTA CARDIOLOGICA SINICA 2016; 30:570-3. [PMID: 27122836 DOI: 10.6515/acs20131102a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED A 64-year-old man with rheumatoid arthritis (RA) presented to our emergency department with severe chest tightness and dyspnea. His electrocardiography (ECG) showed multiple premature atrial complexes (PACs) with wide QRS, and transthoracic echocardiography revealed severe hypokinesis of the left ventricle. The patient later developed sudden cardiovascular collapse with presumed fulminant myocarditis and cardiogenic shock. Further investigation showed that coronary angiogram, viral studies and autoimmune vasculitis markers were all negative. After high-dose intravenous immunoglobulin (IVIG) and systemic steroid were administered, a dramatic improvement of clinical conditions was observed, with an increase of the left ventricular ejection fraction (LVEF) from 10% to 42% within one week, and a resolution of the wide QRS on the ECG. The rapid recovery from left ventricular dysfunction by treatment with IVIG and systemic steroid suggests immunotherapy might be effective in RA patients with acute fulminant myocarditis. KEY WORDS Fulminant myocarditis; Intravenous immunoglobulin; Rheumatoid arthritis; Systemic steroid.
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Affiliation(s)
- Chin-Yu Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; ; Cardiovascular Research Center
| | - Chien-Yi Hsu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; ; Cardiovascular Research Center
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; ; Cardiovascular Research Center; ; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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Pagnoux C, Khalidi NA. Polyarteritis nodosa – Challenges and options in management. INDIAN JOURNAL OF RHEUMATOLOGY 2015. [DOI: 10.1016/j.injr.2015.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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16
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Castellanos D, Travelli FC, Reyhan I, Votava-Smith JK, Ramanathan A, Bar-Cohen Y. Acute Aortic and Mitral Valve Perforations Caused by Granulomatosis With Polyangiitis. Circulation 2015; 131:e527-9. [PMID: 26078373 DOI: 10.1161/circulationaha.114.014304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel Castellanos
- From Department of Pediatrics (D.C.) and Divisions of Cardiology (F.C.T., J.K.V.-S., Y.B.-C.) and Rheumatology (I.R., A.R.), Department of Pediatrics, Children's Hospital Los Angeles, CA; and Keck School of Medicine, University of Southern California, Los Angeles (F.C.T., I.R., J.K.V.-S., A.R., Y.B.-C.)
| | - Frances C Travelli
- From Department of Pediatrics (D.C.) and Divisions of Cardiology (F.C.T., J.K.V.-S., Y.B.-C.) and Rheumatology (I.R., A.R.), Department of Pediatrics, Children's Hospital Los Angeles, CA; and Keck School of Medicine, University of Southern California, Los Angeles (F.C.T., I.R., J.K.V.-S., A.R., Y.B.-C.)
| | - Iris Reyhan
- From Department of Pediatrics (D.C.) and Divisions of Cardiology (F.C.T., J.K.V.-S., Y.B.-C.) and Rheumatology (I.R., A.R.), Department of Pediatrics, Children's Hospital Los Angeles, CA; and Keck School of Medicine, University of Southern California, Los Angeles (F.C.T., I.R., J.K.V.-S., A.R., Y.B.-C.)
| | - Jodie K Votava-Smith
- From Department of Pediatrics (D.C.) and Divisions of Cardiology (F.C.T., J.K.V.-S., Y.B.-C.) and Rheumatology (I.R., A.R.), Department of Pediatrics, Children's Hospital Los Angeles, CA; and Keck School of Medicine, University of Southern California, Los Angeles (F.C.T., I.R., J.K.V.-S., A.R., Y.B.-C.)
| | - Anusha Ramanathan
- From Department of Pediatrics (D.C.) and Divisions of Cardiology (F.C.T., J.K.V.-S., Y.B.-C.) and Rheumatology (I.R., A.R.), Department of Pediatrics, Children's Hospital Los Angeles, CA; and Keck School of Medicine, University of Southern California, Los Angeles (F.C.T., I.R., J.K.V.-S., A.R., Y.B.-C.)
| | - Yaniv Bar-Cohen
- From Department of Pediatrics (D.C.) and Divisions of Cardiology (F.C.T., J.K.V.-S., Y.B.-C.) and Rheumatology (I.R., A.R.), Department of Pediatrics, Children's Hospital Los Angeles, CA; and Keck School of Medicine, University of Southern California, Los Angeles (F.C.T., I.R., J.K.V.-S., A.R., Y.B.-C.).
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The heart in rheumatic disease. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00035-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Hauser B, McRorie E, McKay N, Brenn T, Amft N. A case of hypocomplementaemic urticarial vasculitis with cardiac valve involvement successfully treated with cyclophosphamide and high-dose glucocorticoids. Int J Rheum Dis 2014; 20:1850-1852. [DOI: 10.1111/1756-185x.12360] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Barbara Hauser
- Department of Rheumatology; Western General Hospital; Edinburgh UK
- Rheumatic Diseases Unit; Institute of Genetics and Molecular Medicine; University of Edinburgh; Edinburgh UK
| | - Euan McRorie
- Department of Rheumatology; Western General Hospital; Edinburgh UK
| | - Neil McKay
- Department of Rheumatology; Western General Hospital; Edinburgh UK
| | - Thomas Brenn
- Edinburgh Department of Pathology; Western General Hospital; Edinburgh UK
| | - Nicole Amft
- Department of Rheumatology; Western General Hospital; Edinburgh UK
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Groh M, Masciocco G, Kirchner E, Kristen A, Pellegrini C, Varnous S, Bortman G, Rosenberg M, Brucato A, Waterworth P, Bonacina E, Facchetti F, Calabrese L, Gregorini G, Scali JJ, Starling R, Frigerio M, D'Armini AM, Guillevin L. Heart transplantation in patients with eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome). J Heart Lung Transplant 2014; 33:842-50. [PMID: 24709271 DOI: 10.1016/j.healun.2014.02.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 02/16/2014] [Accepted: 02/19/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Heart involvement is the leading cause of death of patients with eosinophilic granulomatosis with polyangiitis (EGPA; formerly Churg-Strauss syndrome) and is more frequent in anti-neutrophil cytoplasm antibody (ANCA)-negative patients. Post-transplant outcome has only been reported once. METHODS We conducted a retrospective international multicenter study. Patients satisfying the criteria of the American College of Rheumatology and/or revised Chapel Hill Consensus Conference Nomenclature were identified by collaborating vasculitis and transplant specialists, and the help of the Churg-Strauss Syndrome Association. RESULTS Nine ANCA(-) patients who received transplants between October 1987 and December 2009 were identified. The vasculitis and cardiomyopathy diagnoses were concomitant for 5 patients and separated by 12 to 288 months for the remaining 4 patients. Despite ongoing immunosuppression, histologic examination of 7 (78%) patients' explanted hearts showed histologic patterns suggestive of active vasculitis. The overall 5-year survival rate was low (57%), but rose to 80% when considering only the 6 patients transplanted during the last decade. After survival lasting 3 to 60 months, 4 (44%) patients died sudden deaths. CONCLUSIONS The search for EGPA-related cardiomyopathy is mandatory early in the course of this type of vasculitis. Indeed, prompt treatment with corticosteroids and cyclophosphamide may achieve restore cardiac function. Most patients in this series were undertreated. For patients with refractory EGPA, heart transplantation should be performed, which carries a fair prognosis. No optimal immunosuppressive strategy has yet been identified.
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Affiliation(s)
- Matthieu Groh
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, INSERM U1016, Hôpital Cochin, APHP, Université Paris Descartes, Paris, France.
| | - Gabriella Masciocco
- Department of Cardiology and Heart Transplantation, Ospedale Niguarda, Milan, Italy
| | - Elizabeth Kirchner
- Department of Rheumatologic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arnt Kristen
- Department of Cardiology, Angiology, and Respiratory Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Carlo Pellegrini
- Division of Cardiac Surgery, Fondazione I.R.C.C.S. Policlinico San Matteo, University of Pavia School of Medicine, Pavia, Italy
| | - Shaïda Varnous
- Department of Cardiovascular and Thoracic Surgery, Hôpital de la Pitié-Salpêtrière, APHP, Université Pierre-et-Marie-Curie, Paris, France
| | - Guillermo Bortman
- Department of Cardiovascular Surgery, Sanatorio de La Trinidad Mitre, Buenos Aires, Argentina
| | - Mark Rosenberg
- Department of Internal Medicine III (Cardiology and Angiology), University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Antonio Brucato
- Department of Internal Medicine, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Paul Waterworth
- Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester, UK
| | | | - Fabio Facchetti
- Department of Pathology, University of Brescia, Spedali Civili Brescia, Brescia, Italy
| | - Leonard Calabrese
- Department of Rheumatologic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gina Gregorini
- Division of Nephrology, Spedali Civili Brescia, Brescia, Italy
| | - Juan Jose Scali
- Department of Rheumatology, Autoimmune and Metabolic Bone Diseases, Durand Hospital, Buenos Aires, Argentina
| | - Randall Starling
- Heart Failure Center, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Maria Frigerio
- Department of Cardiology and Heart Transplantation, Ospedale Niguarda, Milan, Italy
| | - Andrea Maria D'Armini
- Division of Cardiac Surgery, Fondazione I.R.C.C.S. Policlinico San Matteo, University of Pavia School of Medicine, Pavia, Italy
| | - Loïc Guillevin
- Department of Cardiovascular and Thoracic Surgery, Hôpital de la Pitié-Salpêtrière, APHP, Université Pierre-et-Marie-Curie, Paris, France
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Elston DM. Inflammatory vascular diseases. Dermatopathology (Basel) 2014. [DOI: 10.1016/b978-0-7020-5527-0.00011-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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21
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[Cardiac tamponade and myocarditis in Churg-Strauss syndrome]. Ann Cardiol Angeiol (Paris) 2013; 63:271-5. [PMID: 23806862 DOI: 10.1016/j.ancard.2013.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 03/13/2013] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The successive occurrence of pericardial tamponade and myocarditis during a Churg-Strauss syndrome is exceptionally described. We report a patient in whom pericardial tamponade and myocarditis were the presenting manifestation of a Churg-Strauss syndrome. CASE REPORT A 58-year-old woman was admitted because of alteration of the clinical status with eosinophilia. One month ago, she was hospitalized for a pericardial tamponade treated by pericardial drainage. Acute myocarditis was diagnosed on chest pain during the second hospitalization. The etiologic inquiry ended in the diagnosis of Churg-Strauss complicated with a double cardiac involvement. A good response of clinical and biological anomalies was obtained after corticosteroid and immunosuppressive treatment. CONCLUSION Isolated or multiple involvements of cardiac tunics should lead to make diagnosis of systemic vasculitis. A complete initial assessment and a close observation of the patients followed for Churg-Strauss syndrome is imperative to detect a cardiac achievement and set up an early treatment.
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Szczeklik W, Jakieła B, Adamek D, Musiał J. Cutting edge issues in the Churg-Strauss syndrome. Clin Rev Allergy Immunol 2013; 44:39-50. [PMID: 21380944 DOI: 10.1007/s12016-011-8266-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Churg-Strauss syndrome (CSS) is a rare systemic small-vessel vasculitis that develops in the background of bronchial asthma, which is characterized by eosinophilia and eosinophilic infiltration of various tissues. It belongs to the group of antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitides. The triggering factors and pathogenesis of CSS are still unknown. The possible role of eotaxin-3 and CCR4-related chemokines in selective recruitment of eosinophils to the target tissues in CSS has been recently suggested, but the role of eosinophilic inflammation in the development of vasculitic lesions is not completely understood. From the clinical view, two distinct phenotypes of the disease are slowly emerging depending on the ANCA-positivity status. Glucocorticoids are still the mainstay of treatment; however, data are accumulating regarding the beneficial role of novel immunosuppressants and biologic compounds, especially in patients with poorer prognosis.
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Affiliation(s)
- Wojciech Szczeklik
- Department of Medicine, Jagiellonian University Medical College, Skawińska 8, 31 - 066, Kraków, Poland.
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Comarmond C, Pagnoux C, Khellaf M, Cordier JF, Hamidou M, Viallard JF, Maurier F, Jouneau S, Bienvenu B, Puéchal X, Aumaître O, Le Guenno G, Le Quellec A, Cevallos R, Fain O, Godeau B, Seror R, Dunogué B, Mahr A, Guilpain P, Cohen P, Aouba A, Mouthon L, Guillevin L. Eosinophilic granulomatosis with polyangiitis (Churg-Strauss): clinical characteristics and long-term followup of the 383 patients enrolled in the French Vasculitis Study Group cohort. ACTA ACUST UNITED AC 2013; 65:270-81. [PMID: 23044708 DOI: 10.1002/art.37721] [Citation(s) in RCA: 508] [Impact Index Per Article: 46.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Accepted: 09/20/2012] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Earlier studies of eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (EGPA), with limited patient numbers and followup durations, demonstrated that clinical presentation at diagnosis, but not outcome, differed according to antineutrophil cytoplasmic antibody (ANCA) status. This study was undertaken to describe the main characteristics of a larger patient cohort and their long-term outcomes. METHODS A retrospective study of EGPA patients in the French Vasculitis Study Group cohort who satisfied the American College of Rheumatology criteria and/or Chapel Hill definitions was conducted. Patient characteristics and outcomes were compared according to ANCA status and year of diagnosis. RESULTS We identified 383 patients diagnosed between 1957 and June 2009 (128 [33.4%] before 1997 or earlier) and followed up for a mean±SD of 66.8±62.5 months. At diagnosis, their mean±SD age was 50.3±15.7 years, and 91.1% had asthma (duration 9.3±10.8 years). Main manifestations included peripheral neuropathy (51.4%); ear, nose, and throat (ENT) signs (48.0%); skin lesions (39.7%); lung infiltrates (38.6%); and cardiomyopathy (16.4%). Among the 348 patients tested at diagnosis for ANCA, the 108 ANCA-positive patients (31.0%) had significantly more frequent ENT manifestations, peripheral neuropathy, and/or renal involvement, but less frequent cardiac manifestations, than the ANCA-negative patients. Vasculitis relapses occurred in 35.2% of the ANCA-positive versus 22.5% of the ANCA-negative patients (P=0.01), and 5.6% versus 12.5%, respectively, died (P<0.05). The 5-year relapse-free survival rate was 58.1% (95% confidence interval [95% CI] 45.6-68.6) for ANCA-positive and 67.8% (95% CI 59.8-74.5) for ANCA-negative patients (P=0.35). Multivariable analysis identified cardiomyopathy, older age, and diagnosis during or prior to 1996 as independent risk factors for death and lower eosinophil count at diagnosis as predictive of relapse. CONCLUSION The characteristics and long-term outcomes of EGPA patients differ according to their ANCA status. Although EGPA relapses remain frequent, mortality has declined, at least since 1996.
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Affiliation(s)
- Cloé Comarmond
- Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris 5, Paris, France
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Multimodality imaging and the emerging role of cardiac magnetic resonance in autoimmune myocarditis. Autoimmun Rev 2012; 12:305-12. [DOI: 10.1016/j.autrev.2012.05.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 05/16/2012] [Indexed: 02/05/2023]
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The role of first-pass perfusion deficit in the detection of cardiac subendocardial manifestation in patients with autoimmune vasculitis. Rheumatol Int 2012; 33:29-35. [DOI: 10.1007/s00296-011-2310-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 12/10/2011] [Indexed: 11/25/2022]
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Kobayashi H, Yokoe I, Murata S, Kobayashi Y. A case of microscopic polyangiitis with giant coronary aneurysm. J Rheumatol 2011; 38:583-4. [PMID: 21362797 DOI: 10.3899/jrheum.100924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Shah ASV, Din JN, Payne JR, Dhaun N, Denvir MA, Mills NL. Coronary angiitis and cardiac arrest in antineutrophil cytoplasmic-antibody associated systemic vasculitis. Circulation 2011; 123:e230-1. [PMID: 21321177 DOI: 10.1161/circulationaha.110.981936] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Anoop S V Shah
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK.
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Szczeklik W, Tutaj M, Sokołowska B, Mastalerz L, Miszalski-Jamka T, Dropiński J, Musiał J. Impaired cardiovascular autonomic nervous system function in patients with Churg-Strauss syndrome. Scand J Rheumatol 2011; 40:304-7. [PMID: 21366384 DOI: 10.3109/03009742.2010.549500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Although peripheral nervous system involvement in patients with Churg-Strauss syndrome (CSS) has been described, little is known about its autonomic part. Autonomic nervous system (ANS) function can be assessed by studying heart rate variability (HRV) and a decrease in the spectrum of HRV correlates with ANS impairment. METHODS Out of 24 CSS patients we chose 12 (four males, eight females, aged 40 ± 8.3 years) in disease remission and without cardiac involvement. Twelve age- and sex-matched healthy volunteers served as a control group. All underwent 24-h electrocardiogram (ECG) Holter recordings. HRV was calculated from 1-h segments, including: total power (TP), ultra-low frequency (ULF), very low frequency (VLF), low frequency (LF), and high frequency (HF) powers as well as normalized LF (LF%) and HF (HF%) powers and the LF to HF power ratio (LF/HF). RESULTS The CSS patients showed decreased HRV parameters in the 1-h domains: TP (2038 vs. 3622 ms(2), p = 0.001), HF (561 vs. 1574 ms(2), p < 0.001), LF (672 vs. 1050 ms(2), p < 0.01), and VLF (544 vs. 738 ms(2), p = 0.016). However, LF% and LF/HF ratio were markedly higher in CSS patients than in controls (53.4% vs. 39%, p < 0.001 and 1.1 vs. 0.64, p < 0.001), whereas HF% was lower in CSS than in controls (46.6% vs. 61%, p < 0.001). These results were independent of duration of the disease, eosinophil count, corticosteroids, or peripheral nerve involvement in the past. CONCLUSIONS The CSS patients show impaired HRV parameters, indicating parasympathetic ANS dysfunction in addition to peripheral nervous system involvement.
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Affiliation(s)
- W Szczeklik
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland.
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Szczeklik W, Miszalski-Jamka T, Mastalerz L, Sokolowska B, Dropinski J, Banys R, Hor KN, Mazur W, Musial J. Multimodality assessment of cardiac involvement in Churg-Strauss syndrome patients in clinical remission. Circ J 2010; 75:649-55. [PMID: 21139253 DOI: 10.1253/circj.cj-10-0772] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cardiac involvement in Churg-Strauss syndrome (CSS) is not uncommon, but its frequency varies widely and may depend on the activity of the disease. Therefore, the cardiac involvement in CSS patients in clinical remission was assessed in the present study. METHODS AND RESULTS In 20 CSS patients in remission and 20 sex- and age-matched healthy controls, an ECG stress test, echocardiography, and 24-h ECG Holter monitoring were performed, together with cardiac magnetic resonance imaging (cMRI). Cardiac involvement was present in 90% (18/20) of CSS patients. Left ventricular ejection fraction (LVEF) was on average lower in the CSS group than in controls (P<0.05), with 7 patients showing systolic heart failure (LVEF <50%). cMRI changes included late gadolinium enhancement lesions in the LV in 89% of patients (17/19), present in all layers of the myocardium. Signs of ongoing inflammation (early gadolinium enhancement) and edema (T2-weighted imaging) were present in 6/19 patients. Holter monitoring revealed both supraventricular and ventricular arrhythmias more frequently in CSS patients when compared with controls (P<0.05). Absolute eosinophil count before the initiation of treatment was higher in rhythm disturbances (P<0.05), and inversely correlated with LV systolic function (rho -0.65). CONCLUSIONS Heart involvement in CSS patients who are in clinical remission is very common. It is characterized not only by fibrosis, but also by an active inflammatory process. The latter finding might influence therapeutic decisions in CSS patients in full clinical remission.
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Affiliation(s)
- Wojciech Szczeklik
- Department of Medicine, Jagiellonian University Medical College, Skawi´nska 8, 31-066 Kraków, Poland.
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Sauvetre G, Fares J, Caudron J, Dacher JN, Girszyn N, Daragon A, Levesque H, Marie I. Intérêt de l’imagerie par résonance magnétique nucléaire au cours de l’atteinte cardiaque du syndrome de Churg-Strauss. Trois observations et revue de la littérature. Rev Med Interne 2010; 31:600-5. [DOI: 10.1016/j.revmed.2010.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 03/08/2010] [Accepted: 04/10/2010] [Indexed: 10/19/2022]
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Rassi A, Rassi A. Case 2-2010: a man with abdominal and flank pain. N Engl J Med 2010; 362:1943-4; author reply 1944-5. [PMID: 20484406 DOI: 10.1056/nejmc1001966] [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: 11/19/2022]
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Mavrogeni S, Papadopoulos G, Karanasios E, Georgakopoulos D, Manoussakis M. Microscopic polyangiitis and Kawasaki disease without overt clinical cardiovascular manifestations and with abnormal cardiovascular magnetic resonance findings. Int J Cardiol 2010; 141:e17-9. [DOI: 10.1016/j.ijcard.2008.11.133] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Revised: 11/17/2008] [Accepted: 11/22/2008] [Indexed: 10/21/2022]
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Pagnoux C, Guillevin L. Churg-Strauss syndrome: evidence for disease subtypes? Curr Opin Rheumatol 2010; 22:21-8. [PMID: 19851111 DOI: 10.1097/bor.0b013e328333390b] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Churg-Strauss syndrome (CSS) is a rare systemic small-vessel necrotizing vasculitis. Its main clinical characteristics, some potentially life-threatening, are now well known, as are its usual successive phases, from allergic rhinitis to asthma, and finally vasculitis. Conversely, physiopathogenetic mechanisms are not completely elucidated and clearly multiple, thereby suggesting the existence of different disease subtypes. RECENT FINDINGS Almost 40% of CSS patients have circulating antineutrophil cytoplasm autoantibodies (ANCAs), mostly directed against myeloperoxidase. ANCA-positive patients suffer more frequently from renal disease, peripheral nervous system involvement and/or alveolar hemorrhage, whereas frequent cardiac involvement, lung infiltrates and/or systemic manifestations are more common in those who are ANCA-negative. However, their respective global outcomes do not clearly differ. Patients might also be categorized according to other, more subtle clinical, radiological and/or biological parameters, for example, cardiac magnetic resonance imaging abnormalities or genetic background. SUMMARY Because of its practical and therapeutic repercussions, the priority remains the prompt, relatively easy identification of the most severely affected patients at CSS diagnosis, before searching for and trying to classify subsets. Large, collaborative studies are needed to determine whether other subgroups might be associated with outcomes and warrant different, and possibly new, therapeutic strategies.
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Affiliation(s)
- Christian Pagnoux
- Department of Internal Medicine, French Vasculitis Study Group, National Referral Center for Necrotizing Vasculitides and Systemic Scleroderma, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, Paris, France.
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Mavrogeni S, Manoussakis MN, Karagiorga TC, Douskou M, Panagiotakos D, Bournia V, Cokkinos DV, Moutsopoulos HM. Detection of coronary artery lesions and myocardial necrosis by magnetic resonance in systemic necrotizing vasculitides. ACTA ACUST UNITED AC 2009; 61:1121-9. [PMID: 19644909 DOI: 10.1002/art.24695] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Myocardium and coronary arteries can occasionally be affected in patients with systemic necrotizing vasculitides; however, such involvement has not been systematically assessed using cardiovascular magnetic resonance imaging (MRI). METHODS Magnetic resonance angiography and contrast-enhanced MRI were applied for the assessment of coronary arteries (the left anterior descending [LAD], left circumflex [LCx], and right coronary artery [RCA]) and myocardium, respectively, in 39 patients with vasculitis who were asymptomatic for cardiac disease (16 with microscopic polyangiitis [MPA], 11 with Wegener's granulomatosis [WG], 9 with Churg-Strauss syndrome [CSS], and 3 with polyarteritis nodosa [PAN]). Data were compared with age-matched disease-control patients with rheumatoid arthritis (n = 20) or systemic lupus erythematosus (n = 13), and with healthy control individuals with normal coronaries (n = 40). RESULTS Patients with MPA, WG, and PAN (but not with CSS) were found to display significantly increased maximal diameters of coronary arteries compared with healthy controls (for MPA and WG; P < 0.001 for LAD and RCA, and P < 0.01 for LCx) and with both disease-control groups (for only MPA; P < 0.01 for LAD and RCA, and P < 0.05 for LCx). Fusiform coronary aneurysms were detected in patients with MPA (4/16) and PAN (2/3), whereas coronary ectasias were evident in patients with MPA (14/16) and WG (2/11). The presence of myocardial necrosis (by assessment of late gadolinium-enhanced images) was identified only in patients with MPA (2/16) and CSS (3/8 studied). CONCLUSION Cardiovascular MRI assessment of patients with systemic vasculitis revealed coronary ectatic disease in the majority of patients with MPA and PAN, as well as in several patients with WG. Myocardial necrosis can be detected in MPA and CSS.
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Affiliation(s)
- S Mavrogeni
- Onassis Cardiac Surgery Center, Athens, Greece.
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36
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Abstract
PURPOSE OF REVIEW The heart may be involved in many different ways by the systemic vasculitides. In this review, we focus on recently described diagnostic and therapeutic issues in small and medium vessel vasculitis of the heart. RECENT FINDINGS Data have emerged on the prevalence and significance of cardiac involvement in the systemic vasculitides. There is an increasing array of sophisticated imaging modalities including echocardiography, PET, and cardiac MRI that aid in the clinical diagnosis. SUMMARY Most small and medium vessel vasculitides may involve the heart; however, the mode and incidence of cardiac involvement vary with the different vasculitic syndromes. This review describes the various cardiac manifestations of small and medium vessel vasculitis and the advantages of modern imaging modalities including echocardiography, MRI, and PET coupled with biologic biomarkers such as brain natriuretic peptide and antineutrophilic cytoplasmic antibodies in the diagnosis and management of disease.
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Pujol Farriols R, Aranda Sánchez M. [Clinicopathological conferences of the SEMI]. Rev Clin Esp 2009; 208:584-90. [PMID: 19121275 DOI: 10.1016/s0014-2565(08)76042-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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38
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Inflammatory vascular diseases. Dermatopathology (Basel) 2009. [DOI: 10.1016/b978-0-7020-3023-9.10011-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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39
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Abstract
As systemic immunological disorders inflammatory rheumatic diseases potentially involve organs and structures beyond the musculo-skeletal system including skin and blood vessels. Various neurological, renal, pulmonary, hematological and cardiac manifestations contribute to the broad clinical picture of connective tissue diseases and vasculitides. Regarding cardiac disease all structures of the heart may be affected. Pericarditis in lupus, mitral valve changes in the antiphospholipid syndrome, myocarditis and coronary artery stenosis in the systemic vasculitides are typical examples in systemic rheumatic diseases. Beyond this, pulmonary hypertension in systemic sclerosis or congenital heart block in newborns of lupus patients are further cardiac issues. Since better treatment options led to more long-lasting courses in connective tissue diseases, cardiovascular complications as a consequence of chronic disease- and therapy-related damage gain increasing attention.
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Affiliation(s)
- C Specker
- Klinik für Rheumatologie & Klinische Immunologie, Katholisches Krankenhaus St. Josef, Zentrum für Innere Medizin der Kliniken Essen Süd, Essen, Deutschland.
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