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Echocardiographic features in patients with ANCA-associated vasculitis within 3 months before and after diagnosis

Sung Soo Ahn1, Eun Seong Park1, Seung Min Jung1

  • 1Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.

Clinical Rheumatology
|October 9, 2017
PubMed

Insights

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) patients show reduced heart function and pulmonary hypertension near diagnosis. Echocardiography reveals distinct cardiac patterns across AAV variants.

Area of Science:

  • Cardiology
  • Rheumatology
  • Internal Medicine

Background:

  • Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) can affect multiple organs, including the heart.
  • Echocardiographic findings in AAV patients, particularly around the time of diagnosis, require further elucidation.
  • Understanding cardiac involvement is crucial for managing AAV and improving patient outcomes.

Purpose of the Study:

  • To comprehensively investigate echocardiographic features in patients with ANCA-associated vasculitis (AAV) within three months before and after diagnosis.
  • To compare echocardiographic parameters between AAV patients and healthy controls.
  • To analyze distinct echocardiographic patterns among different variants of AAV: microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA), and eosinophilic GPA (EGPA).

Main Methods:

  • Retrospective review of medical records for 89 AAV patients who underwent echocardiography.
  • Inclusion of 35 age- and gender-matched healthy controls for comparison.
  • Collection and analysis of clinical, laboratory, and echocardiographic data, including left ventricle ejection fraction (LVEF), E/E' ratio, and right ventricle systolic pressure (RVSP).

Main Results:

  • AAV patients exhibited significantly lower mean LVEF (64.0% vs. 69.1%) and higher mean E/E' ratio (11.7 vs. 8.8) and RVSP (30.2 vs. 23.2 mm Hg) compared to controls.
  • MPA patients showed higher rates of systolic and diastolic dysfunction and pulmonary arterial hypertension than controls.
  • GPA patients predominantly displayed diastolic dysfunction, while EGPA patients presented with systolic dysfunction and pulmonary arterial hypertension. No significant differences were found among AAV variants themselves.

Conclusions:

  • Patients with AAV demonstrate impaired systolic function, advanced diastolic dysfunction, and pulmonary arterial hypertension near the time of diagnosis.
  • Distinct echocardiographic patterns are observed across different variants of AAV, suggesting specific cardiac manifestations.
  • Echocardiography is a valuable tool for assessing cardiac involvement in AAV and differentiating between its subtypes.

Keywords:
Antineutrophil cytoplasmic antibody-associated vasculitisEchocardiographyEosinophilic granulomatosis with polyangiitisGranulomatosis with polyangiitisMicroscopic polyangiitis

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