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Cardiac valvular involvement in granulomatosis with polyangiitis in long-term observation
Anna Borowiec1, Magdalena Rosinska2, Ilona Kowalik3
1Medical University of Warsaw, Warsaw, Poland; National Institute of Oncology, Warsaw, Poland.
Insights
Granulomatosis with polyangiitis (GPA) can affect heart valves, with aortic regurgitation being the most common issue. This valvular disease significantly increased over the study period in GPA patients.
Area of Science:
- Cardiology
- Rheumatology
- Immunology
Background:
- Granulomatosis with polyangiitis (GPA) is an antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis.
- Cardiac valvular involvement is a known, though often rare, complication of GPA.
Purpose of the Study:
- To assess cardiac valvular changes in patients with GPA.
- To determine the prevalence and progression of valvular lesions in a GPA cohort.
Main Methods:
- A cohort of 105 GPA patients was followed for a mean of 6.2 years.
- Echocardiography and laboratory tests were performed on all participants.
- Multivariate analysis was used to identify predictors of valvular changes.
Main Results:
- Aortic regurgitation (AR) was the most common valvular lesion at baseline (43%).
- AR significantly increased during the observation period (p=0.01).
- Elevated D-dimer levels were the only significant predictor of AR (OR 8.0).
Conclusions:
- Cardiac valve involvement is common in GPA, but significant disease is rare.
- Aortic regurgitation is the most frequent valvular complication in GPA patients.
- The aortic valve is particularly susceptible to degeneration in GPA.
Introduction And Objectives:
Granulomatosis with polyangiitis (GPA) is an antineutrophil cytoplasmic autoantibody (ANCA)-associated systemic vasculitis and is characterized by inflammation of blood vessels. The aim of the present study was to assess cardiac valvular changes in patients with GPA in a cohort of 105 patients followed for a mean of six years.
Methods:
We followed 105 patients (mean age 50.4 years, 67 female) for a mean of 6.2±1.3 years. Echocardiography and laboratory tests were performed in all patients.
Results:
At baseline, 43% of patients were diagnosed with aortic regurgitation (AR), which was the most common valvular lesion. Moreover, it was the only valvular involvement that significantly increased during observation (p=0.01). In a multivariate model, only D-dimer level was a predictor of AR in this group of patients (OR 8.0 (95% CI: 1.7-38.2, p=0.01).
Conclusions:
Involvement of the heart valves is a common finding in patients with GPA, but significant valvular disease is a rare complication. The most common valvular disease in this group of patients is AR. Aortic valves are also the most prone to degeneration in the course of the vasculitis.
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