Clinical and Echocardiographic Predictors of Major Adverse Cardiovascular Events in ANCA-Associated Vasculitis

Background and Objectives: Cardiovascular disease is the leading cause of mortality in patients with ANCA-associated vasculitis (AAV) after the first year post-diagnosis. This study investigated relationships between traditional risk factors, echocardiographic findings, disease activity, and major adverse cardiovascular events (MACE) in AAV patients. Aim: This retrospective single-center study aimed to evaluate the impact of traditional cardiovascular risk factors and echocardiographic parameters on the occurrence of MACE in patients with AAV. Materials and Methods: This study included adult patients with AAV who were evaluated between 2020 and 2025. Data collected included demographics, cardiovascular risk factors, Birmingham Vasculitis Activity Score version 3 (BVASv3), laboratory parameters, immunosuppressive therapy, and transthoracic echocardiography (TTE) findings. MACE was defined as myocardial infarction, stroke, revascularization, cardiovascular hospitalization, or cardiovascular death. Results: The cohort comprised 32 females (61.5%) and 20 males (38.5%), with a mean age of 62.4 ± 12.4 years. MACE occurred in 38.5% of patients. Male gender (p = 0.002), overweight (p = 0.016), hyperlipidemia (p = 0.003), and prior cardiovascular disease (p = 0.002) were significantly associated with MACE in univariate analyses. Patients with MACE had larger left atrial anteroposterior dimensions on the parasternal long-axis view (median 3.9 vs. 3.3 cm, p = 0.002) and lower left ventricular ejection fraction assessed by the modified biplane Simpson's method (median 53% vs. 60%, p = 0.002). Valvular dysfunction was not associated with MACE in a statistically significant manner. Disease activity markers (BVASv3 and CRP) showed no significant correlation with cardiovascular events or echocardiographic parameters. Conclusions: Our results demonstrate that traditional cardiovascular risk factors are stronger determinants of MACE in AAV patients than disease-specific parameters. Cardiac structural changes, including left atrial dilation and decreased left ventricular ejection fraction, were significantly associated with cardiovascular outcomes. These findings underscore the importance of integrating systematic cardiovascular risk assessment and aggressive risk factor modification into standard AAV management protocols.