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Cardiac involvement in non-specific aorto-arteritis
1Department of Cardiology, Institute of Post-Graduate Medical Education and Research, Calcutta, India.
Insights
Non-specific aorto-arteritis frequently impacts the heart, causing cardiac failure, hypertension, and valve issues in young adults. This study highlights significant cardiac complications in patients with this inflammatory condition.
Area of Science:
- Cardiology
- Rheumatology
- Internal Medicine
Background:
- Non-specific aorto-arteritis (Takayasu arteritis) is a large vessel vasculitis affecting the aorta and its branches.
- Cardiac involvement is a serious complication, but its spectrum and prevalence require further elucidation.
Purpose of the Study:
- To comprehensively evaluate cardiac manifestations in patients diagnosed with non-specific aorto-arteritis.
- To assess the impact of this vasculitis on cardiac function, hemodynamics, and coronary arteries.
Main Methods:
- A cohort of 75 patients with non-specific aorto-arteritis underwent detailed clinical examination.
- Echocardiography, cardiac catheterization with angiography, and coronary angiography were performed.
- Histopathological analysis of cardiac tissues was conducted.
Main Results:
- Cardiac failure was observed in 27 patients, characterized by reduced ejection fraction (25-48%).
- Systemic hypertension was prevalent (60 cases), with elevated central aortic and left ventricular pressures in 66 cases.
- Aortic regurgitation (15 cases), mitral regurgitation (12 cases), and pulmonary hypertension (6 cases) were noted. Coronary artery obstruction occurred in 6 patients. Dilated cardiomyopathy was seen in 3 patients.
Conclusions:
- Non-specific aorto-arteritis significantly affects cardiovascular health, leading to diverse cardiac complications including heart failure, hypertension, and valve dysfunction.
- Early detection and management of cardiac involvement are crucial for improving outcomes in patients with this condition.
Abstract:
Cardiac involvement in 75 cases (mean age 21.1 +/- 6 years) with non-specific aorto-arteritis was studied. Detailed clinical examination, echocardiography and cardiac catheterization, including angiography, were done in all the cases, as was coronary angiography. Features of cardiac failure like sinus tachycardia, cardiomegaly, left ventricular third heart sound gallop and pulmonary congestion were detected in 27 cases with reduction of left ventricular ejection fraction (25-48%). Systemic hypertension was seen in 60 cases. Central aortic pressure, left ventricular systolic pressure and left ventricular end-diastolic pressure were increased in 66 cases. Pulmonary hypertension and increased pulmonary vascular resistance were detected in 6 cases. Aortic and mitral regurgitation were seen in 15 and 12 cases, respectively. Three patients had features of dilated cardiomyopathy such as generalized cardiomegaly, systemic and pulmonary congestion but without any cardiac murmurs and with normal central aortic pressure. The coronary angiogram revealed obstruction of the left anterior descending artery in 3 cases and right coronary artery obstruction in another 3 cases. Histopathological studies revealed non-specific inflammatory changes with fibrosis in cardiac musculature and the great vessels.