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Cardiac disease in patients with vasculitis
Leonhard Binzenhöfer1, Katharina Strauß1, Linus Seifert1
1Medizinische Klinik Und Poliklinik I, Munich, Germany and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Klinikum Der Universität München, Munich, Germany.
Insights
Cardiac complications in vasculitis are uncommon but risk factors and heart abnormalities are prevalent. Systematic screening and multidisciplinary care are recommended for patients with vasculitis.
Area of Science:
- Cardiology
- Rheumatology
- Systemic Vasculitis
Background:
- Cardiac involvement is a known complication of vasculitides, often linked to poorer patient outcomes.
- Limited data exists on the specific incidence of structural and arrhythmic heart disease in vasculitis patients.
Purpose of the Study:
- To investigate the incidence of structural and arrhythmic heart disease in patients diagnosed with various forms of vasculitis.
- To identify cardiovascular risk factors and cardiac abnormalities in a cohort of vasculitis patients.
Main Methods:
- A single-center study involving 191 patients with giant-cell arteritis (GCA), Takayasu arteritis (TAK), polyarteritis nodosa (PAN), granulomatosis with polyangiitis (GPA), or eosinophilic granulomatosis with polyangiitis (EGPA).
- Cardiac imaging included echocardiography (70%) and cardiac magnetic resonance (11%).
- Analysis of demographic characteristics, baseline comorbidities, and treatment regimens.
Main Results:
- While severe cardiac complications were rare, cardiovascular risk factors like hypertension and dyslipidemia were common, particularly in GCA.
- Cardiac magnetic resonance revealed left ventricular systolic dysfunction and myocardial fibrosis in 33% and 40% of EGPA patients, respectively.
- Acute myocardial infarction occurred in GCA patients; coronary angiography showed intervention needs varied by vasculitis type.
Conclusions:
- A significant proportion of vasculitis patients exhibit cardiovascular risk factors, structural heart abnormalities, and arrhythmias.
- Despite rare severe events, systematic cardiac screening and multidisciplinary management are crucial for vasculitis patients.
- Early detection and management of cardiac involvement can potentially improve outcomes in vasculitis.
Background:
Cardiac involvement has been described in many forms of vasculitides and is associated with worse outcomes. However, data on the incidence of structural and arrhythmic heart disease is limited.
Methods:
For this single-center study, we recruited 191 patients with giant-cell arteritis (GCA, n = 109), Takayasu arteritis (TAK, n = 26), polyarteritis nodosa (PAN, n = 3), granulomatosis with polyangiitis (GPA, n = 38), or eosinophilic granulomatosis with polyangiitis (EGPA, n = 15) between August 2023 and January 2025. The primary study endpoint was the incidence of structural or arrhythmic heart disease after the diagnosis of vasculitis.
Results:
The demographic characteristics of patients diagnosed with vasculitis differed significantly between those with GCA, TAK, PAN, GPA, and EGPA. Arterial hypertension and dyslipidemia at baseline were more prevalent among patients with GCA, while chest pain and signs of congestion were more frequently reported by patients with EGPA. No significant difference between the five main subgroups were found regarding the incidence of documented arrhythmic diseases. Cardiac imaging was performed using echocardiography in 70% of the overall cohort and cardiac magnetic resonance (CMR) in 11%. CMR detected left ventricular systolic dysfunction and myocardial fibrosis in 33% and 40% of EGPA patients, respectively. All four cases of acute myocardial infarction occurred in patients with GCA. Among 19 GCA patients who underwent coronary angiography, 21.1% underwent percutaneous coronary intervention. In the EGPA group, coronary angiography was performed in 46.7% of patients, but none required percutaneous intervention. A substantial proportion of patients was treated with acetylsalicylic acid (50.3%), beta-blockers (41.9%), or ACE-inhibitors/AT1-receptor antagonists (60.2%).
Conclusion:
Severe cardiac complications occurred rarely, although cardiovascular risk factors, structural abnormalities, and arrhythmias affected a substantial proportion of patients with vasculitis, highlighting the potential benefit of systematic screening and multidisciplinary management.
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