Mid-aortic syndrome is associated with increased left ventricular mass index in Takayasu arteritis

Mid-aortic syndrome (MAS) may induce changes in cardiac structure among patients with Takayasu arteritis (TA).

Consecutive adult patients with TA (January 1, 2011 to January 1, 2018) were enrolled and their data was retrospectively analyzed.

Patients were divided into MAS group (100/457 patients, 21.8%) and non-MAS group (357, 78.1%). The left ventricular mass index (LVMI) was higher in the MAS group than the non-MAS (113.78±26.82 versus 100.74±23.66 g/m², respectively; P<0.001). The MAS group showed higher prevalence than the non-MAS group of mild-to-severe mitral regurgitation (9.0% and 3.9%, respectively; P=0.040) and aortic regurgitation (26% and 14.8%, respectively; P=0.003). No difference was found in the rates of heart failure (27.0% and 19.9% for MAS and non-MAS, respectively; P=0.126). The MAS group also showed lower estimated glomerular filtration rates than the non-MAS group (89.93±18.89 versus 96.16±21.60 mL/min/1.73 m², respectively; P=0.009) and higher prevalence of renal artery stenosis (57% versus 43.7%; P=0.018). MAS was independently related to greater LVMI in both unadjusted model [β=12.60; 95% confidence interval (CI): 7.09-18.11; P<0.001] and the model adjusted for multiple indices (β=9.91; 95% CI: 4.57-15.25; P<0.001) in multivariate linear analysis. The LVMI significantly decreased from 111.49±25.65 to 100.36±22.91 g/m² (P<0.001) among 55 patients who underwent successful revascularization treatment for MAS, while no significant difference (P=0.635) was observed among patients treated with medicine alone.

TA-induced MAS is a potential independent risk factor for increased LVMI, and revascularization therapy for MAS is effective in reversing structural changes in the heart.