Spectrum of Aortic Disease in the Giant Cell Arteritis Population

Area of Science:

• Cardiovascular Medicine
• Rheumatology
• Vascular Biology

Background:

• Giant cell arteritis (GCA) is a systemic vasculitis primarily affecting large arteries.
• Aortic involvement is a known complication of GCA, but its spectrum and progression require further elucidation.
• Understanding aortic disease progression in GCA is crucial for timely diagnosis and management.

Purpose of the Study:

• To characterize the spectrum of aortic involvement in patients diagnosed with GCA.
• To determine the prevalence and characteristics of aortopathy, including aneurysm/dilation and dissection, in GCA patients.
• To compare the aneurysmal growth rate in GCA with degenerative aortic disease and identify risk factors for dissection.

Main Methods:

• Retrospective review of medical records for 4,006 patients.
• Inclusion of patients with confirmed GCA diagnosis and available aortic imaging studies.
• Analysis of aortic imaging findings, including aneurysm/dilation, growth rates, and dissection events.

Main Results:

• Of 1,450 patients with GCA, 974 underwent aortic imaging, revealing aortopathy in 435 (45%).
• Aneurysm/dilation was the most common aortopathy (69%), with an average annual growth rate of 1.5 mm/year.
• Aortic dissection occurred in 18 patients (6%), associated with a significantly higher growth rate (4.5 mm/year) compared to those without dissection (1.4 mm/year).
• Dissections occurred at a median aortic size of 51 mm, with 39% occurring when the maximal diameter was less than 50 mm.

Conclusions:

• GCA is associated with a higher aortic aneurysmal growth rate than degenerative aortic disease.
• Patients with GCA experiencing aortic dissection exhibit accelerated growth rates.
• A significant proportion of aortic dissections in GCA patients occur at aortic diameters below 50 mm, highlighting the need for vigilant monitoring.