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Clinical Characteristics of Heart Involvement in Chinese Patients with Takayasu Arteritis
Jing Li1,2, Hongchao Li1,2, Fei Sun1,2
1From the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education; Department of Rheumatology, Ji-shui-tan Hospital, Beijing, China.
Insights
Heart involvement is common in Takayasu arteritis (TA) patients, particularly those with Numano type V vessel involvement. Echocardiogram screening is recommended for comprehensive TA patient assessment.
Area of Science:
- Cardiology
- Rheumatology
- Vascular Medicine
Background:
- Takayasu arteritis (TA) is a rare, chronic inflammatory disease affecting large arteries.
- Cardiac complications significantly impact TA patient prognosis and management.
- Understanding the specific characteristics of heart involvement in TA is crucial for early diagnosis and treatment.
Purpose of the Study:
- To investigate the prevalence and clinical features of cardiac abnormalities in a Chinese cohort of Takayasu arteritis patients.
- To identify factors associated with heart involvement in TA.
- To evaluate the utility of echocardiography in assessing cardiac manifestations of TA.
Main Methods:
- Retrospective review of medical records of 411 Chinese patients diagnosed with Takayasu arteritis.
- Comparison of clinical characteristics between patients with and without cardiac involvement.
- Analysis of specific cardiac abnormalities including valvular, myocardial, and coronary artery involvement.
- Assessment of vessel involvement patterns (Numano classification) and inflammatory markers.
Main Results:
- Cardiac abnormalities were observed in 164 out of 411 TA patients (40%).
- Patients with heart involvement had a longer disease duration and higher incidence of hypertension, renal dysfunction, and subclavian bruit.
- Valvular abnormalities (81.7%), myocardial abnormalities (15.9%), and coronary artery abnormalities (11.6%) were frequently detected.
- Numano type V vessel involvement was prevalent in patients with myocardial (84.6%), coronary artery (78.9%), and valvular (66.4%) abnormalities.
- Elevated high-sensitivity C-reactive protein levels were associated with heart involvement.
Conclusions:
- Cardiac abnormalities are a significant and frequent complication of Takayasu arteritis, especially in cases with Numano type V vessel involvement.
- Echocardiography is a valuable diagnostic tool for identifying and monitoring cardiac involvement in TA patients.
- Early screening for cardiac complications should be considered in the management of TA.
Objective:
To understand the characteristics of heart involvement in Chinese patients with Takayasu arteritis (TA).
Methods:
The medical charts of 411 patients with TA (325 women, 86 men) were retrospectively reviewed. The comparison of clinical manifestations was carried out between the patients with TA with (n = 164) and without (n = 247) heart involvement.
Results:
The median age at disease onset was 23.0 years (18.0-30.0) in 411 patients with TA, and 23.0 years (17.3-30.0) in 164 patients with heart involvement. The disease duration of the heart involvement group (median: 24.0 mos) was significantly longer than those patients without heart involvement (the control group, median: 16.0 mos). Hypertension (57.3% vs 46.6%; p = 0.033), renal dysfunction (17.1% vs 7.7%; p = 0.003), and bruit in the subclavian artery (45.1% vs 34.4%; p = 0.029) were more common in the heart involvement group than patients without. Valvular abnormalities were found in 134 (81.7%) patients in the heart involvement group, myocardial abnormalities in 26 (15.9%), and coronary artery abnormalities in 19 patients (11.6%). The age at onset (yrs) and disease duration (mos) of patients with myocardial, valvular, and coronary arterial abnormalities were 18.8/13.0, 23.8/23.5, and 26.8/57.0, respectively. In the heart involvement group, 22 patients (84.6%) with myocardial abnormalities, 15 (78.9%) with coronary arterial abnormalities, and 89 (66.4%) with valvular abnormalities had Numano type V vessel involvement. The level of high-sensitivity C-reactive protein was higher in the heart involvement group (median: 10.0 mg/l), and the difference was significant when compared to the control group (median: 7.0 mg/l; p = 0.017).
Conclusion:
Patients with TA complicated with cardiac abnormalities are not rare, especially in patients with Numano type V vessel involvement. We suggest that echocardiogram screening may be a helpful tool to understand the whole feature of patients with TA.
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