Impaired cardiac and vascular motion in patients with Takayasu's arteritis: A velocity vector imaging-based study

Left ventricular strain in patients with Takayasu arteritis with preserved ejection fraction: an analysis using cardiac magnetic resonance imaging feature tracking

Background

The alteration of myocardial strain in patients with Takayasu arteritis (TAK) remains unclear. This study aimed to evaluate left ventricular (LV) stain in patients with TAK and preserved left ventricular ejection fraction (pLVEF) using cardiac magnetic resonance imaging feature tracking (CMR-FT) to analyze risk factors for impaired LV strain and to compare the baseline difference of LV strain between patients with reduced and nonreduced LVEF at 6-month follow-up.

Methods

In all, 51 patients with TAK and 30 healthy controls were prospectively enrolled. All participants underwent multiple short- and long-axis cine scans with true fast imaging with steady-state precession sequence. In this observational study, LV global and regional longitudinal, circumferential, and radial strain and their strain rates were analyzed with FT on cine images. The relationship between LV strain and clinical data was explored. The baseline LV strain between patients with TAK and reduced and nonreduced LVEF was compared using transthoracic echocardiography (TTE) at the 6-month follow-up.

Results

Patients with TAK with pLVEF showed a decline in baseline global longitudinal peak strain (GLS) [TAK (-13.35%±3.11%) vs. controls (-14.77%±1.74%), P=0.021] and circumferential peak strain (GCS) [TAK (-21.46%±2.66%) vs. controls (-22.75%±2.57%), P=0.027] in comparison with normal controls. The longitudinal peak strain (LPS) in the apical (P=0.003) and midventricular regions (P=0.027) and the circumferential peak strain (CPS) in the basal (P=0.021) and midventricular regions (P=0.008) also decreased in patients with TAK. Patients with pulmonary hypertension (PH) or myocardial late gadolinium enhancement (LGE) showed a greater reduction in strain compared with those without PH or LGE. GLS showed a negative association with erythrocyte sedimentation rate (ESR), while GCS showed a positive association with disease duration. In the 30 patients who were followed up, the baseline global and apical circumferential diastolic peak strain rates (DPSR) in patients with reduced LVEF were higher than those in patients without reduced LVEF.

Conclusions

In patients with TAK and pLVEF, CMR-FT indicated that both global and segmental myocardial strain decreased. PH, male gender, long disease duration, elevated ESR, and myocardial LGE were associated with declined LV strain. Baseline increased circumferential DPSR may be associated with the decline in LVEF during follow-up.

A preliminary study of changes in carotid artery elasticity in type 2 diabetes mellitus

BACKGROUND

Carotid stiffening is found to be present in patients with type 2 diabetes mellitus (T2DM) together with endothelial dysfunction and it remains unclear about the role of carotid elasticity in the development of diabetic vascular damage. The aim of the study was to investigate changes and significance of carotid artery elasticity in diabetic patients with or without microvascular complications using velocity vector imaging (VVI) analysis.

METHODS

Fifty participants were enrolled and divided into health Control group, the uncomplicated DM (uDM) group and the complicated DM (cDM) group. All of them underwent carotid ultrasound examinations. VVI was used to evaluate the common carotid artery (CCA) elasticity and intima-media thickness (IMT) was also measured. Flow-mediated dilation (FMD) was performed to detect the vascular endothelial function. Then differences and correlations of variables between three groups were compared and analyzed.

RESULTS

CCA elasticity measured by VVI decreased significantly between three groups (p < 0.05), while FMD decreased significantly only in cDM group (p < 0.01) and only IMT in cDM group was significantly thicker than that of Control group (p < 0.05). Representative VVI variables were independently, negatively related to the known duration and microalbuminuria (p < 0.05). All VVI variables were significantly correlated with FMD (0.5 ≤ |r | <0.8, p < 0.001), and just a small part of VVI variables were significantly correlated with IMT (0.3 ≤ |r | <0.5, p < 0.05).

CONCLUSION

Compared with FMD, CCA elasticity measured by VVI showed more obvious changes in diabetic patients with different levels of vascular damage and may be considered as an alternative indicator in evaluating arterial status of T2DM.

Higher body mass index and disease duration are associated with increased risk of left ventricular diastolic dysfunction in women with systemic lupus erythematosus

BACKGROUND

Patients with systemic lupus erythematosus (SLE) have an increased cardiovascular (CV) risk. Insulin resistance (IR), which is higher in patients with SLE, adversely impacts left ventricular (LV) remodeling and function. The aims were to determine LV dysfunction and evaluate the influence of potential risk factors on subclinical LV dysfunction in women with SLE, including IR.

METHODS

This cross-sectional study included adult women with SLE without diabetes mellitus (DM), hypertension or severe obesity. Diastolic dysfunction (DD) was verified according to current guidelines. Insulin resistance was estimated using the Quantose score.

RESULTS

We included 77 women. The frequency of IR was 65%. All participants had a normal ejection fraction (EF), and 11 (15.7%) had abnormal LV global longitudinal strain (GLS). Twenty-three (32.8%) had DD. The GLS% and global circumferential strain (GCS)% did not differ in patients with and without IR (-20.8 ± 3.1 vs -20.5 ± 2.1; p = 0.61 and -27.9 ± 4.4 vs -27.4 ± 3.7; p = 0.57, respectively). The prevalence of DD was 38.1% in patients with IR versus 25% in those without (p = 0.30). E/e' and E/A ratios did not differ between groups (6.6 ± 1.9 vs 6.6 ± 1.5; p = 0.98 and 1.3 ± 0.3 vs 1.3 ± 0.2; p = 0.27). Higher BMI (OR: 1.2, 95% CI 1.1-1.5) and disease duration (OR: 1.2, 95% CI 1.1-1.4) were associated with DD.

CONCLUSIONS

Patients with overweight/obesity may be at higher risk of LV dysfunction. Although IR was high in our patients with SLE was not associated with systolic dysfunction or DD. Body mass index and disease duration were associated with an increased risk of DD.

Arterial Stiffness and Adult Onset Vasculitis: A Systematic Review

Chronic inflammation represents the cornerstone of the raised cardiovascular (CV) risk in patients with inflammatory rheumatic diseases (IRD), including vasculitis. Standardized mortality ratios in these patients are higher as compared to the general population, and the excess of premature mortality is due to early atherosclerotic events. Thus, IRD patients need appropriate CV risk assessment and management according to this CV disease (CVD) burden. Adequate control of CV risk is still lacking in usual care, but early diagnosis of silent and subclinical CVD is crucial to improve the long-term prognosis of these patients. Increased arterial stiffness may provide a pathophysiological link between inflammation and increased cardiovascular risk. Several noninvasive methods are now available to estimate artery stiffness in the clinical setting, including pulse wave velocity assessment. The independent predictive value of arterial stiffness for cardiovascular events has been demonstrated in general as well as in selected populations, and reference values adjusted for age and blood pressure have been suggested. Thus, arterial stiffness is an interesting biomarker for cardiovascular risk stratification. This systematic review summarizes the additional value that PWV measurement can provide in the setting of vasculitis, with a focus in the different clinical stages and CV risk prevention. This systematic review is registered with registration number: Prospero CRD42021259603.