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Persu A, Dobrowolski P, Gornik HL, Olin JW, Adlam D, Azizi M, Boutouyrie P, Bruno RM, Boulanger M, Demoulin JB, Ganesh SK, Guzik T, Januszewicz M, Kovacic JC, Kruk M, Leeuw DP, Loeys B, Pappaccogli M, Perik M, Touzé E, Van der Niepen P, Van Twist DJL, Warchoł-Celińska E, Prejbisz A, Januszewicz A. Current progress in clinical, molecular, and genetic aspects of adult fibromuscular dysplasia. Cardiovasc Res 2021; 118:65-83. [PMID: 33739371 DOI: 10.1093/cvr/cvab086] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 03/17/2021] [Indexed: 12/11/2022] Open
Abstract
Fibromuscular dysplasia (FMD) is a non-atherosclerotic vascular disease that may involve medium-sized muscular arteries throughout the body. The majority of FMD patients are women. Although a variety of genetic, mechanical, and hormonal factors play a role in the pathogenesis of FMD, overall, its cause remains poorly understood. It is probable that the pathogenesis of FMD is linked to a combination of genetic and environmental factors. Extensive studies have correlated the arterial lesions of FMD to histopathological findings of arterial fibrosis, cellular hyperplasia, and distortion of the abnormal architecture of the arterial wall. More recently, the vascular phenotype of lesions associated with FMD has been expanded to include arterial aneurysms, dissections, and tortuosity. However, in the absence of a string of beads or focal stenosis, these lesions do not suffice to establish the diagnosis. While FMD most commonly involves renal and cerebrovascular arteries, involvement of most arteries throughout the body has been reported. Increasing evidence highlights that FMD is a systemic arterial disease and that subclinical alterations can be found in non-affected arterial segments. Recent significant progress in FMD-related research which has led to improved understandings of the disease's clinical manifestations, natural history, epidemiology, and genetics. Ongoing work continues to focus on FMD genetics and proteomics, physiological effects of FMD on cardiovascular structure and function, and novel imaging modalities and blood-based biomarkers that can be used to identify subclinical FMD. It is also hoped that the next decade will bring the development of multi-centred and potentially international clinical trials to provide comparative effectiveness data to inform the optimal management of patients with FMD.
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Affiliation(s)
- Alexandre Persu
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique and Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Piotr Dobrowolski
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Heather L Gornik
- University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH, USA
| | - Jeffrey W Olin
- Zena and Michael A. Wiener Cardiovascular Institute and Marie-José and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Adlam
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester University, Leicester, UK
| | - Michel Azizi
- Université de Paris, INSERM CIC1418, Paris, France.,AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, Paris, France
| | - Pierre Boutouyrie
- Université de Paris, INSERM U970 Team 7, Paris, France.,AP-HP, Hôpital Européen Georges-Pompidou, Pharmacology Department and DMU CARTE, Paris, France
| | - Rosa Maria Bruno
- Université de Paris, INSERM U970 Team 7, Paris, France.,AP-HP, Hôpital Européen Georges-Pompidou, Pharmacology Department and DMU CARTE, Paris, France
| | - Marion Boulanger
- Normandie Université, UNICAEN, Inserm U1237, CHU Caen Normandie, Caen, France
| | | | - Santhi K Ganesh
- Division of Cardiovascular Medicine, Department of Internal Medicine, and Department of Human Genetics University of Michigan, Ann Arbor, Michigan, USA
| | - Tomasz Guzik
- Jagiellonian University, Collegium Medicum, Krakow, Poland.,Institute of Cardiovascular & Medical Sciences BHF Glasgow Cardiovascular Research Centre; Glasgow, UK
| | | | - Jason C Kovacic
- Zena and Michael A. Wiener Cardiovascular Institute and Marie-José and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Victor Chang Cardiac Research Institute, Darlinghurst, Australia, and St. Vincent's Clinical School, University of NSW, Australia
| | - Mariusz Kruk
- Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland
| | - de Peter Leeuw
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Heerlen, The Netherlands.,Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Bart Loeys
- Center for Medical Genetics, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Marco Pappaccogli
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique and Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.,Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Melanie Perik
- Center for Medical Genetics, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | | | - Patricia Van der Niepen
- Department of Nephrology & Hypertension, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB) Brussels, Belgium
| | | | | | - Aleksander Prejbisz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
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4
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Pappaccogli M, Prejbisz A, Ciurică S, Bruno RM, Aniszczuk-Hybiak A, Bracalente I, De Backer T, Debiève F, Delmotte P, Di Monaco S, Jarraya F, Gordin D, Kosiński P, Kroon AA, Maas AHEM, Marcon D, Minuz P, Montagud-Marrahi E, Pasquet A, Poch E, Rabbia F, Stergiou GS, Tikkanen I, Toubiana L, Vinck W, Warchoł-Celińska E, Van der Niepen P, de Leeuw P, Januszewicz A, Persu A. Pregnancy-Related Complications in Patients With Fibromuscular Dysplasia: A Report From the European/International Fibromuscular Dysplasia Registry. Hypertension 2020; 76:545-553. [PMID: 32639884 DOI: 10.1161/hypertensionaha.120.15349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Current literature suggests a higher risk of pregnancy-related complications in patients with renal fibromuscular dysplasia (FMD). The aim of our study was to assess the nature and prevalence of pregnancy-related complications in patients subsequently diagnosed with FMD. A call for participation was sent to centers contributing to the European/International FMD Registry. Patients with at least 1 pregnancy were included. Data on pregnancy were collected through medical files and FMD characteristics through the European/International FMD Registry. Data from 534 pregnancies were obtained in 237 patients. Despite the fact that, in 96% of cases, FMD was not diagnosed before pregnancy, 40% of women (n=93) experienced pregnancy-related complications, mostly gestational hypertension (25%) and preterm birth (20%), while preeclampsia was reported in only 7.5%. Only 1 patient experienced arterial dissection and another patient an aneurysm rupture. When compared with patients without pregnancy-related complications, patients with complicated pregnancies were younger at FMD diagnosis (43 versus 51 years old; P<0.001) and had a lower prevalence of cerebrovascular FMD (30% versus 52%; P=0.003) but underwent more often renal revascularization (63% versus 40%, P<0.001). In conclusion, the prevalence of pregnancy-related complications such as gestational hypertension and preterm birth was high in patients with FMD, probably related to the severity of renal FMD. However, the prevalence of preeclampsia and arterial complications was low/moderate. These findings emphasize the need to screen hypertensive women for FMD to ensure revascularization before pregnancy if indicated and appropriate follow-up during pregnancy, without discouraging patients with FMD from considering pregnancy.
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Affiliation(s)
- Marco Pappaccogli
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy (M.P., S.D.M., F.R.).,Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (M.P., S.D.M., A. Pasquet, A. Persu).,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (M.P., S.D.M., A. Pasquet, A. Persu)
| | - Aleksander Prejbisz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland (A. Prejbisz, A.A.-H., E.W.-C., A.J.)
| | - Simina Ciurică
- Cardiology Department, Marie Curie Civil Hospital, CHU Charleroi, Lodelinsart, Belgium (S.C.)
| | - Rosa Maria Bruno
- Department of Clinical and Experimental Medicine University of Pisa, Italy (R.M.B., I.B.).,INSERM U970 Team 7, Paris Cardiovascular Research Centre - PARCC & Université de Paris, Paris, France (R.M.B.)
| | - Anna Aniszczuk-Hybiak
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland (A. Prejbisz, A.A.-H., E.W.-C., A.J.)
| | - Irene Bracalente
- Department of Clinical and Experimental Medicine University of Pisa, Italy (R.M.B., I.B.)
| | - Tine De Backer
- Department of Cardiovascular Diseases, University Hospital Ghent, Belgium (T.D.B.)
| | - Frédéric Debiève
- Obstetrics Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium (F.D.)
| | | | - Silvia Di Monaco
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy (M.P., S.D.M., F.R.).,Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (M.P., S.D.M., A. Pasquet, A. Persu).,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (M.P., S.D.M., A. Pasquet, A. Persu)
| | - Faiçal Jarraya
- Service de Néphrologie, CHU Hédi Chaker, Sfax, Tunisie/Unité de Recherche 12ES14 Pathologie rénale, Faculté de medicine, Sfax (F.J.)
| | - Daniel Gordin
- Helsinki Hypertension Centre of Excellence (D.G., I.T.), University of Helsinki, Helsinki University Hospital, Finland.,Abdominal Center Nephrology (D.G., I.T.), University of Helsinki, Helsinki University Hospital, Finland.,Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Finland (D.G.)
| | - Przemysław Kosiński
- Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland (P.K.)
| | - Abraham A Kroon
- Department of Internal Medicine, Division of General Internal Medicine, Section Vascular Medicine (A.A.K., P.d.L.), Maastricht University Medical Centre, Maastricht University, the Netherlands.,CARIM School for Cardiovascular Diseases (A.A.K., P.d.L.), Maastricht University Medical Centre, Maastricht University, the Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (A.H.E.M.M.)
| | - Denise Marcon
- Department of Medicine, Unit of General Medicine and Hypertension, University of Verona, Italy (D.M., P.M.)
| | - Pietro Minuz
- Department of Medicine, Unit of General Medicine and Hypertension, University of Verona, Italy (D.M., P.M.)
| | | | - Agnès Pasquet
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (M.P., S.D.M., A. Pasquet, A. Persu).,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (M.P., S.D.M., A. Pasquet, A. Persu)
| | - Esteban Poch
- Service de Cardiologie, CHU Ambroise Paré, Mons, Belgium (P.D.)
| | - Franco Rabbia
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy (M.P., S.D.M., F.R.)
| | - George S Stergiou
- Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Greece (G.S.S.)
| | - Ilkka Tikkanen
- Helsinki Hypertension Centre of Excellence (D.G., I.T.), University of Helsinki, Helsinki University Hospital, Finland.,Abdominal Center Nephrology (D.G., I.T.), University of Helsinki, Helsinki University Hospital, Finland.,Minerva Institute for Medical Research, Helsinki, Finland (I.T.)
| | - Laurent Toubiana
- Sorbonne Université, Université Paris 13, Sorbonne Paris Cité, INSERM, UMR_S1142, LIMICS, IRSAN, France (L.T.)
| | - Wouter Vinck
- Endocrinology Department, Saint-Augustinus Hospital, Wilrijk, Belgium (W.V.)
| | - Ewa Warchoł-Celińska
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland (A. Prejbisz, A.A.-H., E.W.-C., A.J.)
| | - Patricia Van der Niepen
- Department of Nephrology and Hypertension, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium (P.V.d.N.)
| | - Peter de Leeuw
- Department of Internal Medicine, Division of General Internal Medicine, Section Vascular Medicine (A.A.K., P.d.L.), Maastricht University Medical Centre, Maastricht University, the Netherlands.,CARIM School for Cardiovascular Diseases (A.A.K., P.d.L.), Maastricht University Medical Centre, Maastricht University, the Netherlands
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland (A. Prejbisz, A.A.-H., E.W.-C., A.J.)
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (M.P., S.D.M., A. Pasquet, A. Persu).,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (M.P., S.D.M., A. Pasquet, A. Persu)
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