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Yamamoto K, Sato T, Salem H, Chen YW, Matsumura M, Bletnitsky N, Fall KN, Prasad M, Ng VG, Sethi SS, Nazif TM, Parikh SA, Vahl TP, Ali ZA, Karmpaliotis D, Rabbani LE, Collins MB, Leon MB, McEntegart MB, Moses JW, Kirtane AJ, Mintz GS, Maehara A. Ostial right coronary artery lesion morphology and outcomes after treatment with drug-eluting stents. EUROINTERVENTION 2024; 20:e207-e215. [PMID: 38343369 PMCID: PMC10836391 DOI: 10.4244/eij-d-23-00406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/12/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND Outcomes after percutaneous coronary intervention (PCI) for de novo ostial right coronary artery (RCA) lesions are poor. AIMS We used intravascular ultrasound (IVUS) to clarify the morphological patterns of de novo ostial RCA lesions and their associated clinical outcome. METHODS Among 5,102 RCA IVUS studies, 170 de novo ostial RCA stenoses (within 3 mm from the aorto-ostium) were identified. These were classified as 1) isolated ostial lesions (no disease extending beyond 10 mm from the ostium and without a calcified nodule [CN]); 2) ostial CN, typically with diffuse disease (disease extending beyond 10 mm); and 3) ostial lesions with diffuse disease but without a CN. The primary outcome was target lesion failure (TLF: cardiac death, target vessel myocardial infarction, definite stent thrombosis, and ischaemia-driven target lesion revascularisation). RESULTS The prevalence of an isolated ostial lesion was 11.8% (n=20), 47.6% (n=81) were ostial CN, and 40.6% (n=69) were ostial lesions with diffuse disease. Compared to ostial lesions with diffuse disease, isolated lesions were more common in women (75.0% vs 42.0%; p=0.01), and CN were associated with older age (median [first, third quartile] 76 [70, 83] vs 69 [63, 81] years old; p=0.002). The Kaplan-Meier rate of TLF at 2 years was significantly higher in patients with CN (21.6%) compared to diffuse lesions (8.2%) (p=0.04), and patients with isolated lesions had no events. A multivariable Cox proportional hazard model revealed that CN were significantly associated with TLF (hazard ratio 6.63, 95% confidence interval: 1.28-34.3; p=0.02). CONCLUSIONS Ostial RCA lesions have specific morphologies - detectable by IVUS - that may be associated with long-term clinical outcomes.
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Affiliation(s)
- Kei Yamamoto
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Takao Sato
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Hanan Salem
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
- Cardiovascular Medicine Department, Tanta University Hospitals, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Yu-Wei Chen
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Nikolas Bletnitsky
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Khady N Fall
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Megha Prasad
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Vivian G Ng
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Sanjum S Sethi
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Tamim M Nazif
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Sahil A Parikh
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Torsten P Vahl
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Ziad A Ali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
- St. Francis Hospital, Roslyn, New York, NY, USA
| | - Dimitri Karmpaliotis
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
| | - LeRoy E Rabbani
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Michael B Collins
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Martin B Leon
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Margaret B McEntegart
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Jeffery W Moses
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
- St. Francis Hospital, Roslyn, New York, NY, USA
| | - Ajay J Kirtane
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Akiko Maehara
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
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Yuan SM, Lin HZ. Coronary artery involvements in Takayasu arteritis: systematic review of reports. Gen Thorac Cardiovasc Surg 2020; 68:883-904. [PMID: 32430746 DOI: 10.1007/s11748-020-01378-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/28/2020] [Indexed: 12/12/2022]
Abstract
Coronary artery involvements in patients with Takayasu arteritis (TA) have not been sufficiently described. By comprehensive retrieval of the pertinent literature published in the past two decades, 59 reports including 141 patients were recruited into this study. In TA patients with coronary artery involvements, the right coronary artery was the most commonly affected. Stenosis was the most common coronary artery lesion, and the coronary ostium was the most commonly affected coronary segment. Acute myocardial infarction was diagnosed in 17 (12.1%) patients of this cohort. Patients receiving surgical treatment showed a higher recovery rate than interventionally treated patients. Interventional therapy was associated with a higher reintervention rate than surgical treatment. The inflammation condition in TA patients can lead to in-stent restenosis and warrant reinterventions. Surgical treatment is a preferable treatment of choice over interventional therapy for the coronary artery lesions of TA patients.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian, People's Republic of China
| | - Hui-Zhen Lin
- Department of Clinical Laboratory, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, 389 Longdejing Street, Chengxiang District, Putian, 351100, Fujian, People's Republic of China.
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Li J, Li H, Sun F, Chen Z, Yang Y, Zhao J, Li M, Tian X, Zeng X. Clinical Characteristics of Heart Involvement in Chinese Patients with Takayasu Arteritis. J Rheumatol 2017; 44:1867-1874. [DOI: 10.3899/jrheum.161514] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2017] [Indexed: 11/22/2022]
Abstract
Objective.To understand the characteristics of heart involvement in Chinese patients with Takayasu arteritis (TA).Methods.The medical charts of 411 patients with TA (325 women, 86 men) were retrospectively reviewed. The comparison of clinical manifestations was carried out between the patients with TA with (n = 164) and without (n = 247) heart involvement.Results.The median age at disease onset was 23.0 years (18.0–30.0) in 411 patients with TA, and 23.0 years (17.3–30.0) in 164 patients with heart involvement. The disease duration of the heart involvement group (median: 24.0 mos) was significantly longer than those patients without heart involvement (the control group, median: 16.0 mos). Hypertension (57.3% vs 46.6%; p = 0.033), renal dysfunction (17.1% vs 7.7%; p = 0.003), and bruit in the subclavian artery (45.1% vs 34.4%; p = 0.029) were more common in the heart involvement group than patients without. Valvular abnormalities were found in 134 (81.7%) patients in the heart involvement group, myocardial abnormalities in 26 (15.9%), and coronary artery abnormalities in 19 patients (11.6%). The age at onset (yrs) and disease duration (mos) of patients with myocardial, valvular, and coronary arterial abnormalities were 18.8/13.0, 23.8/23.5, and 26.8/57.0, respectively. In the heart involvement group, 22 patients (84.6%) with myocardial abnormalities, 15 (78.9%) with coronary arterial abnormalities, and 89 (66.4%) with valvular abnormalities had Numano type V vessel involvement. The level of high-sensitivity C-reactive protein was higher in the heart involvement group (median: 10.0 mg/l), and the difference was significant when compared to the control group (median: 7.0 mg/l; p = 0.017).Conclusion.Patients with TA complicated with cardiac abnormalities are not rare, especially in patients with Numano type V vessel involvement. We suggest that echocardiogram screening may be a helpful tool to understand the whole feature of patients with TA.
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Majumdar G, Kapoor A, Agarwal SK, Srivastava N, Rao RN, Soni N. Chronic Periaortitis of Ascending Aorta With Bilateral Ostial Coronary Stenosis in a Young Female. Ann Thorac Surg 2017; 103:e427-e429. [PMID: 28431717 DOI: 10.1016/j.athoracsur.2016.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/12/2016] [Accepted: 11/06/2016] [Indexed: 10/19/2022]
Abstract
An 18-year-old woman without any risk factors for coronary artery disease or systemic vasculitis and infection presented with recurrent angina at rest. Coronary angiography revealed 100% occlusion of the ostial left main coronary artery and severe ostial right coronary artery stenosis. She underwent successful coronary artery bypass graft surgery. At surgery, the external surface of the ascending aorta was covered with a soft-tissue thickened mass; histopathology of the mass revealed chronic nonspecific inflammatory aortitis.
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Affiliation(s)
- Gauranga Majumdar
- Department of Cardiovascular and Thoracic Surgery, Sanjay Gandhi PGIMS, Lucknow, India
| | - Aditya Kapoor
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India.
| | - Surendra K Agarwal
- Department of Cardiovascular and Thoracic Surgery, Sanjay Gandhi PGIMS, Lucknow, India
| | - Navneet Srivastava
- Department of Cardiovascular and Thoracic Surgery, Sanjay Gandhi PGIMS, Lucknow, India
| | - Ram Nawal Rao
- Department of Pathology, Sanjay Gandhi PGIMS, Lucknow, India
| | - Neetu Soni
- Department of Radiology, Sanjay Gandhi PGIMS, Lucknow, India
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Yang Y, Tian T, Yang K, Zhang Y, Meng X, Fan P, Feng L, Mu C, Gao L, Zhou X. Outcomes of percutaneous coronary intervention and coronary artery bypass grafting in patients with Takayasu arteritis. Int J Cardiol 2017; 241:64-69. [PMID: 28237733 DOI: 10.1016/j.ijcard.2017.02.041] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/10/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Coronary artery involvement is not a rare presentation of Takayasu arteritis (TA) and the treatment is challenging. The optimal methods of revascularization, and prognosis of treatment have not been established. OBJECTIVES To assess the long-term outcomes of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in TA patients. METHODS Patients with coronary artery involved in TA who underwent either PCI or CABG were identified between February 2003 and December 2015. The primary outcome was long-term all-cause mortality. Secondary outcomes were myocardial infarction (MI), stroke, and repeat revascularization. RESULTS Thirty-one patients were enrolled (PCI=19 vs. CABG=12). Most of them were female (25, 80.6%) and the mean age was 42.6±13.8years (16-64years). Angina pectoris was the most common initial symptom (26 cases, 83.9%) and concomitant aortic regurgitation was present in 8 (25.8%) patients. Both groups had a low rate of corticosteroids use [4/19 (21.1%) vs. 2/12 (16.7%)]. During the median follow-up of 101months (10-384months), PCI group had a significantly higher incidence of restenosis [12/19(63.2%) vs. 3/12(25%)]. Two patients with severe aortic regurgitation in PCI group suffered from cardiac death during follow-up. CONCLUSIONS Coronary artery involvement should be suspected in TA patients with angina pectoris, especially young women. PCI had a very high rate of in-stent restenosis in patients without corticosteroids and CABG may be a preferred treatment option.
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Affiliation(s)
- Yankun Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Tao Tian
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Kunqi Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ying Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xu Meng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Peng Fan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Lei Feng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Chaowei Mu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Linggen Gao
- Department of Geriatric Cardiology, General Hospital of Chinese People's Liberation Army, Beijing 100853, China
| | - Xianliang Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
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Aortitis-related isolated bilateral coronary artery ostial stenosis in a young woman with acute coronary syndrome. Int J Cardiol 2016; 223:111-112. [PMID: 27537733 DOI: 10.1016/j.ijcard.2016.08.096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/05/2016] [Indexed: 11/22/2022]
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Wang X, Dang A. Prognostic Value of Brachial-Ankle Pulse Wave Velocity in Patients With Takayasu Arteritis With Drug-Eluting Stent Implantation. Arthritis Care Res (Hoboken) 2015; 67:1150-7. [PMID: 25708244 DOI: 10.1002/acr.22563] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 01/10/2015] [Accepted: 01/27/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study investigates the long-term outcomes of drug-eluting stent (DES) implantation in patients with Takayasu arteritis (TAK). METHODS Data on 48 TAK patients and 40 age-, sex-, and severity-matched patients with coronary artery disease (CAD) receiving DES implantation and hospitalized in Fuwai Hospital from February 2004 to March 2014 were assessed. The clinical features, laboratory data, coronary angiographic findings, treatment, and followup outcomes were summarized retrospectively. Major adverse cardiac events (MACE), which include all-cause death, nonfatal myocardial infarction, and nonfatal target vessel revascularization, were recorded. RESULTS TAK patients exhibited increased mean ± SD brachial-ankle pulse wave velocity (baPWV) compared with patients with CAD (17.0 ± 3.8 versus 13.8 ± 3.0 meters/second; P = 0.002). However, CAD patients had higher levels of low-density lipoprotein cholesterol (2.5 ± 1.0 versus 2.3 ± 0.8 mmoles/liter; P = 0.04). Multiple linear regression analysis revealed that baPWV was independently associated with the extent of CAD, assessed by the SYNTAX (Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery) score (β = 0.33, P = 0.03), in TAK patients. DES implantation was deployed in 73 coronary lesions in 48 TAK patients, and restenosis occurred in 48 lesions after an average of 25.6 months (range 9.0-68.0 months) following intervention. Logistic regression analysis identified that a baPWV of 17.00 meters/second or higher (odds ratio 5.50, 95% confidence interval [95% CI] 2.1-16.6, P = 0.008) may be considered as an independent predictor of DES restenosis. Moreover, the multivariate Cox proportional hazards model demonstrated that a baPWV of 17.00 meters/second or higher (hazard ratio 3.36, 95% CI 1.51-7.52, P = 0.003) was significant and may serve as an independent predictor of MACE in TAK patients who underwent DES implantation. CONCLUSION DES in-stent restenosis remains a challenge, affecting the long-term outcomes of patients with TAK. Measuring increased arterial stiffness through baPWV, with the addition of inflammation status monitoring during followup, would be of great clinical value to identify TAK patients with DES who have a high risk for in-stent restenosis and MACE.
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Affiliation(s)
- Xu Wang
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Aimin Dang
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Wang X, Dang A, Lv N, Liu Q, Chen B. High-sensitivity C-reactive protein predicts adverse cardiovascular events in patients with Takayasu arteritis with coronary artery involvement. Clin Rheumatol 2015; 35:679-84. [PMID: 25665822 DOI: 10.1007/s10067-015-2873-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 01/11/2015] [Accepted: 01/13/2015] [Indexed: 11/27/2022]
Abstract
The study aimed to assess the association of high-sensitivity C-reactive protein (hsCRP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) to major adverse cardiovascular events (MACE) in Takayasu arteritis (TA) patients with coronary artery disease (CAD). Data on 60 TA patients with CAD and 60 age- and severity-matched patients with CAD hospitalized in Fuwai Hospital from 2005 to August 2014 were assessed. The clinical features, laboratory data, coronary angiographic findings, treatment, and follow-up outcomes were summarized retrospectively. MACE were defined as death from cardiac causes, myocardial infarction, nonfatal target vessel revascularization, or rehospitalization due to unstable or progressive angina. CAD patients had more atherogenic lipid and lipoprotein profiles such as lower levels of high-density lipoprotein cholesterol (HDL-C) (1.0 ± 0.2 vs. 1.3 ± 0.3 mmol/L, p = 0.01) and higher levels of low-density lipoprotein cholesterol (LDL-C) (2.5 ± 0.9 vs. 2.2 ± 1.1 mmol/L, p = 0.04) in contrast with TA-CAD patients. During a mean follow-up period of 3.2 years, 31 patients with Takayasu coronary arteritis reached the endpoint. Multivariate Cox proportional hazards model demonstrated that log(hsCRP) (HR = 5.3, 95 % CI = 1.1-27.8, p = 0.04) was a significant and independent predictor of MACE in patients with Takayasu coronary arteritis. Elevated baseline levels of hsCRP predict cardiovascular events, independent of other prognostic markers in TA-related CAD patients.
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Affiliation(s)
- X Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
| | - A Dang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China.
| | - N Lv
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
| | - Q Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
| | - B Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
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Abstract
Takayasu arteritis (TA) is a chronic idiopathic and granulomatous vasculitis, manifesting mainly as a panaortitis. Autoimmune cell-mediated immunity is probably responsible for the disease. The inflammation commences from the adventitia and progresses to the intima and leads to, both in adults and children, segmental stenosis, occlusion, dilatation, and/or aneurysm formation. This review focuses briefly on the etiopathogenesis, and describes the pathological and clinical features in adults and children.
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Affiliation(s)
- Pradeep Vaideeswar
- Department of Pathology, (Cardiovascular and Thoracic Division), Seth GS Medical College, Mumbai, Maharashtra, India
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Sun T, Zhang H, Ma W, Yang L, Jiang X, Wu H, Hui R, Zheng D. Coronary Artery Involvement in Takayasu Arteritis in 45 Chinese Patients. J Rheumatol 2013; 40:493-7. [DOI: 10.3899/jrheum.120813] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.We investigated the clinical characteristics, potential difficulties in diagnosis, and therapy for coronary artery involvement in patients with Takayasu arteritis (TA).Methods.Of 587 consecutive patients hospitalized with TA from 1998 to 2011, those found to have > 50% reduction of diameter of coronary artery by angiography were recruited. We defined the first finding of coronary involvement as baseline. The clinical features, laboratory data, coronary angiographic findings, treatment, and followup outcomes were summarized retrospectively.Results.A total of 45 (7.7%, 45/587) patients with coronary involvement were identified, including 40 with typical angina, and 15 with myocardial infarction. Some had complications such as peripheral vascular murmur, pulseless disease, and hypertension. The average age at onset of cardiac symptoms was 40.3 ± 12.8 years (range 15–64) and 36 were female. At admission, erythrocyte sedimentation rates were elevated in 27 patients (60%) and C-reactive protein levels in 23 (51.1%). The ostia (37.4%) and proximal segments (33.3%) of coronary artery were most frequently involved. The treatment was stent implantation in 10 patients and coronary artery bypass grafting in 13. One female patient suffered sudden death during the angiography. During a mean followup of 5.8 ± 4.5 years, 8 patients died.Conclusion.Coronary artery involvement in TA that leads to cardiovascular events, especially to cardiovascular death, is not rare. Early diagnosis and therapy should be emphasized.
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Coronary CT angiography in Takayasu arteritis. JACC Cardiovasc Imaging 2012; 4:958-66. [PMID: 21920333 DOI: 10.1016/j.jcmg.2011.04.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 04/21/2011] [Accepted: 04/26/2011] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The aim of this study was to use coronary computed tomographic (CT) angiography to characterize coronary artery involvement in patients with known Takayasu arteritis who present with anginal chest pain or shortness of breath. BACKGROUND Takayasu arteritis is a primary vasculitis of the large vessels, which mainly affects the aorta and its branches but can also involve the coronary arteries. Coronary CT angiography allows visualization of the coronary vessels and can be used to detect both stenotic and nonstenotic coronary artery lesions. METHODS Eighteen consecutive patients with Takayasu arteritis and angina (typical or atypical) and/or dyspnea underwent contrast-enhanced 64-slice coronary CT angiography. The arterial injury was classified according to the Numano classification. Three patients had prior known coronary artery disease. Coronary arteries were evaluated concerning the presence of obstructive and nonobstructive lesions, and differences between the clinical presentations of patients with and without coronary artery involvement on CT angiography were analyzed. RESULTS Coronary artery involvement was found in 8 patients (44.4%), 3 of them with clinical activity. A total of 19 coronary lesions were present (13 in ostial locations, 5 in proximal coronary artery segments, and 1 in a mid segment). Eight lesions exceeded 50% diameter reduction (2 in ostial locations and 6 in proximal coronary artery segments). Median disease duration was significantly different between patients with coronary artery involvement (176 months; range 13 to 282 months) compared with those without (21 months; range 1 to 142 months) (p = 0.013). CONCLUSIONS Coronary CT angiography allows the assessment of coronary artery involvement in patients with Takayasu arteritis. These data confirm prior observations that most coronary lesions are in ostial or proximal coronary artery locations. Disease duration in patients with coronary artery involvement is longer than in patients without.
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12
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Syphilitic coronary artery ostial stenosis resulting in acute myocardial infarction treated by percutaneous coronary intervention. Case Rep Med 2010; 2010:830583. [PMID: 21052501 PMCID: PMC2967841 DOI: 10.1155/2010/830583] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 09/27/2010] [Accepted: 10/06/2010] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular abnormalities are well-known manifestations of tertiary syphilis infections which although not frequent, are still causes of morbidity and mortality. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We report a case of a 46-year-old male admitted due to acute anterior ST elevation myocardial infarction submitted to primary percutaneous coronary intervention successfully. Coronary angiography showed a suboccluded ostial lesion of left main coronary artery. VDRL was titrated to 1/512. The patient was discharged with treatment including benzathine penicillin. Previous case reports of acute myocardial infarction in association with syphilitic coronary artery ostial stenosis have been reported, but the fact that the patient was treated by percutaneous coronary intervention is unique in this case.
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