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Vats V, Patel K, Sharma DD, Almansouri NE, Makkapati NSR, Nimal S, Ramteke P, Mohammed Arifuddin B, Jagarlamudi NS, Narain A, Raut YD. Exploring Cardiovascular Manifestations in Vasculitides: An In-Depth Review. Cureus 2023; 15:e44417. [PMID: 37791229 PMCID: PMC10543473 DOI: 10.7759/cureus.44417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
Systemic vasculitides encompass a cluster of autoimmune diseases that affect blood vessels, and are characterized by immune-mediated injury to either small- or large-sized blood vessels. Individuals afflicted with systemic vasculitides experience notable morbidity and mortality attributable to cardiovascular manifestations. Noteworthy among these are ischemic heart disease, venous thromboembolism, aortic involvement, valvular irregularities, myocarditis, and pericarditis. This narrative review investigated and evaluated the prevalent cardiovascular disturbances commonly associated with different types of vasculitides. This review also discusses the mechanisms that underlie these manifestations. It also provides a thorough explanation of the many diagnostic techniques essential for detecting the disease at its occult stage. It is essential for healthcare professionals to have knowledge of the cardiovascular complications caused by vasculitides, as this enables them to promptly recognize these symptoms and employ suitable diagnostic techniques early on. By doing so, timely detection can be ensured, which will subsequently aid in initiating appropriate treatment strategies that are vital for decreasing morbidity and mortality in patients with systemic vasculitides.
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Affiliation(s)
- Vaibhav Vats
- Internal Medicine, Smt. Kashibai Navale Medical College and General Hospital, Mumbai, IND
| | - Kriyesha Patel
- Internal Medicine, MP Shah Medical College, Jamnagar, IND
| | | | | | | | - Simran Nimal
- Internal Medicine, Byramjee Jeejeebhoy (BJ) Government Medical College, Pune, IND
| | - Palash Ramteke
- Medical School, NKP Salve Institute of Medical Sciences, Nagpur, IND
| | | | | | - Archit Narain
- Internal Medicine, Lala Lajpat Rai Memorial Medical College, Meerut, IND
| | - Yogesh D Raut
- Miscellaneous, NKP Salve Institute of Medical Sciences, Nagpur, IND
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Asaad Estfan Y, DCruz D, Patel S, Saha M. An unusual and potentially fatal cause of scalp crusting. Clin Exp Dermatol 2017; 42:441-443. [DOI: 10.1111/ced.13045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Y. Asaad Estfan
- Dermatology Department; Queen Elizabeth Hospital; Lewisham and Greenwich NHS Trust; London UK
| | - D. DCruz
- Rheumatology Department; Guys and St Thomas' NHS Foundation Trust; London UK
| | - S. Patel
- Rheumatology Department; Guys and St Thomas' NHS Foundation Trust; London UK
| | - M. Saha
- Dermatology Department; Queen Elizabeth Hospital; Lewisham and Greenwich NHS Trust; London UK
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Goel PK, Moorthy N, Kumar S. The Role of Noninvasive Imaging in Early Diagnosis of Clinically Masked Prepulseless Inflammatory Phase of Takayasu's Arteritis. Echocardiography 2012; 29:59-63. [DOI: 10.1111/j.1540-8175.2011.01581.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Keenan NG, Mason JC, Maceira A, Assomull R, O'Hanlon R, Chan C, Roughton M, Andrews J, Gatehouse PD, Firmin DN, Pennell DJ. Integrated cardiac and vascular assessment in Takayasu arteritis by cardiovascular magnetic resonance. ACTA ACUST UNITED AC 2009; 60:3501-9. [DOI: 10.1002/art.24911] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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[Takayasu arteritis in southern Tunisia: a study of 29 patients]. Presse Med 2009; 38:1410-4. [PMID: 19524396 DOI: 10.1016/j.lpm.2008.10.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 09/25/2008] [Accepted: 10/06/2008] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES This study aimed to assess the clinical, laboratory, and radiological features and course of Takayasu arteritis in Tunisia. METHODS This retrospective study analyzed 29 patients with Takayasu arteritis between 1996 and 2006 who met the criteria for inclusion proposed by the American College of Rheumatology (ACR). RESULTS The file review identified 25 women and 4 men, with a mean age at diagnosis of 35.4 years (range: 18-65 years). Our series included 93% with involvement of the aortic arch and its branches, while only 24% involved renal arteries and 21% the abdominal aorta. We had no case with cardiac or pulmonary involvement. In all, 67.7% had type I disease, 10.7% type IIb, 3.6% type IV and 25% type V. Hypertension was recorded in 38%. No tuberculosis was observed. In all, 22 patients (75.8%) had glucocorticoid treatment, and 5 (17.2%) needed immunosuppressive therapy. Two patients with renal artery stenosis had endoluminal angioplasty and four patients (13.7%) required surgical intervention. Our patients were followed for a mean period of 80 months. Disease remained stable in 18 patients (64.2%). CONCLUSION The clinical manifestations, angiographic data and course of our patients were similar to those in other reported series. We found no relation between Takayasu arteritis and tuberculosis.
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Soto ME, Espinola-Zavaleta N, Ramirez-Quito O, Reyes PA. Echocardiographic follow-up of patients with Takayasu's arteritis: five-year survival. Echocardiography 2006; 23:353-60. [PMID: 16686616 DOI: 10.1111/j.1540-8175.2006.00238.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Takayasu's arteritis (TA) is a primary vasculitis that causes stenosis or occlusion, rarely aneurysm and distal ischemia. This study was undertaken to examine cardiovascular damage using echocardiography and determine the causes of morbid-mortality in Mexican Mestizo patients with TA. Seventy-six patients were studied by transthoracic echocardiography. Left ventricular diameters, parietal thickness, systolic function, and wall motion were analyzed, also, valvular lesions and aorta features were assessed. Thickness of the interventricular septum was 12 mm +/- 3 (8-19), and that of posterior wall was 12 mm +/- 2 (9-18). The average left ventricular diastolic diameter was 47 mm +/- 7 (33-68) and the left ventricular systolic diameter 32 mm +/- 8 (16-64). The left ventricular ejection fraction was of 57 +/- 11%. Left ventricular concentric hypertrophy was found in 28 (50%) of the 56 hypertensive patients. The five-year survival of patients with left ventricular concentric hypertrophy was 80%, compared to 95% in patients without hypertrophy (P = 0.00). Abnormal wall motion was found in 15 patients. Thirty-one patients had aortic regurgitation, 19 had mitral regurgitation, 13 had tricuspid regurgitation, and 10 and pulmonary hypertension. Six patients had aneurysms of ascending aorta and 7 stenosis of descending aorta. Thirteen of 76 patients died (17%), 85% were hypertensive, and 9% also had acute myocardial infarction (AMI). Echocardiography, a noninvasive technique, shows a great utility in detection and follow-up of cardiovascular manifestations in patients with TA. New techniques, more sensitive toward detecting the early stages of left ventricular dysfunction, are promising to limit left ventricular hypertrophy development.
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Affiliation(s)
- María Elena Soto
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
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Abstract
Six patients with aortoarteritis complicating aortic regurgitation (14.0%) were found by ascending aorta angiography, seven patients (4. 2%) were found by echocardiography and 30 patients (27.3%) were found by color Doppler echocardiography in our group. Among 43 patients, mild in 21 patients (48.9%), moderate in 17 patients (39.5%) and severe in five patients (11.6%) were determined. Four patients had angina pectories due to myocardial ischemia, but coronary angiography were normal. The aortic valve thickening was found by echocardiography in three patients and aortic valve replacement was performed in two patients in our series.
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Affiliation(s)
- Z Deyu
- Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 100037, Beijing, China
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Amano J, Suzuki A, Tanaka H, Sunamori M. Surgical treatment for annuloaortic ectasia in Takayasu arteritis. Int J Cardiol 1998; 66 Suppl 1:S197-202; discussion S203-4. [PMID: 9951820 DOI: 10.1016/s0167-5273(98)00169-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Annuloaortic ectasia (AAE) associated with aortic regurgitation (AR) is a rare involvement in Takayasu arteritis. There are many difficult problems in surgical treatment of this lesion because of its inflammatory nature. We developed a composite graft repair technique to avoid complications associated with Bentall type procedures for treatment of AAE+AR. The technique consists of a double proximal suturing and direct coronary artery reimplantation as a Carrel patch without wrapping. Eight patients (one male, seven females) received this composite graft repair for treatment of AAE+AR due to Takayasu arteritis. Of them, two patients were in active phase. There was one hospital death probably due to ventricular arrhythmia, however, no late death occurred. And there were no late complications related to operative procedures. Thus, our composite graft repair technique for treatment of AAE+AR in Takayasu arteritis can prevent major complications associated with Bentall type procedures. However, close serial follow-up, careful control of inflammation, and early detection and treatment of other vascular involvements are necessary in the postoperative management of patients with Takayasu arteritis.
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Affiliation(s)
- J Amano
- Department of 2nd Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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Abstract
Takayasu arteritis is usually defined as a chronic, progressive, inflammatory, occlusive disease of the aorta and its branches. However, we should remind Takayasu arteritis as a systemic disease. Here I describe nonclassical and catastrophic manifestations of the Takayasu arteritis, which often go unrecognized until after the event. Especially I stress that we should focus on cardiopulmonary complications in Takayasu arteritis.
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Affiliation(s)
- J T Lie
- Department of Pathology, University of California, Davis School of Medicine and University of California, Davis Medical Center, Sacramento 95817, USA
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Cañas CA, Jimenez CA, Ramirez LA, Uribe O, Tobón I, Torrenegra A, Cortina A, Muñoz M, Gutierrez O, Restrepo JF, Peña M, Iglesias A. Takayasu arteritis in Colombia. Int J Cardiol 1998; 66 Suppl 1:S73-9. [PMID: 9951805 DOI: 10.1016/s0167-5273(98)00153-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Takayasu arteritis has been recognized in Colombia just recently, and so far we do not have any report concerning its presentation here. In this first report, some issues related to the presentation of the disease are indicated and compared with those found in the medical literature. No differences were found in age and sex. Most of the cases were diagnosed during an inactive phase of the disease with advanced manifestations due to vascular lesion which suggests the existence of some genetic factor influencing such a presentation, or may be the consequence of a delay in diagnosing the disease during initial and active stages due to not suspecting it. Comparing the vessels which are affected among other races and countries, we can find both differences and similarities. With the purpose of discovering the demographic, clinical, angiographic and laboratorial characteristics of Takayasu arteritis in Colombia, the present study was carried out by studying 35 clinical cases in different medical centers of the country.
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Affiliation(s)
- C A Cañas
- Universidad Nacional de Colombia, Santaf é de Bogotá
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Numano F, Kobayashi Y, Maruyama Y, Kakuta T, Miyata T, Kishi Y. Takayasu arteritis: clinical characteristics and the role of genetic factors in its pathogenesis. Vasc Med 1998; 1:227-33. [PMID: 9546941 DOI: 10.1177/1358863x9600100307] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Takayasu arteritis is a chronic vasculitis, the aetiology of which is still unknown. Several characteristic clinical manifestations have led scientists to consider the possibility of the genetic factors in the aetiology, conjecture which is supported by HLA analysis. Recent attention has focused on the different clinical manifestations among Asian and South American countries and further progress is likely to stem from international network studies.
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Affiliation(s)
- F Numano
- 3rd Department of Internal Medicine, Tokyo Medical and Dental University, Japan
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Abstract
Takayasu arteritis (TA) is a chronic inflammatory and obliterative disease of large vessels particularly the aorta and its major branches. Recently, the disease has been shown to involve the parenchyma of various organs. Specific glomerular lesions reported in patients with TA are mesangial proliferative, membrano-proliferative, crescentic glomerulonephritis and amyloidosis. Dermatological manifestations of this disease are erythema nodosum, facial lupus rash and erythema induratum. Dilated cardiomyopathy, myocarditis and pericarditis have been reported in TA. Rarely, interstitial lung disease, pneumonic consolidation, idiopathic ulcerative colitis, rheumatoid arthritis and polymyositis have been described in association with TA. In this report, five patients of TA with primary parenchymatous involvement of kidneys, skin, heart and gastrointestinal tract have been described. An association of primary parenchymatous organ involvement and TA suggests an autosensitization to an unidentified antigen in the pathogenesis of TA.
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Affiliation(s)
- B K Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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