Dilated cardiomyopathy in Wegener's granulomatosis

Long-term cardiovascular outcomes and temporal trends in patients diagnosed with ANCA-associated vasculitis: a Danish nationwide registry study

OBJECTIVES

To examine long-term cardiovascular outcomes and temporal trends among patients with ANCA-associated vasculitis (AAV) using Danish nationwide registries.

METHODS

Using a cohort design, we examined patients with granulomatosis with polyangiitis (ICD-10: DM31.3) and microscopic polyangiitis (ICD-10: DM3.17) in Denmark from 1996-2018. Hazard ratios (HRs) of cardiovascular outcomes were compared between patients with AAV and age and gender-matched controls. Counterfactual G-estimation of HRs was performed to estimate 5-year absolute risks. Temporal trends were obtained by grouping cohorts into evenly distributed tertiles according to inclusion year.

RESULTS

A total of 2306 patients with AAV (median age: 62.9yrs, 52.6% male) were matched with 6918 controls. Median follow-up was 9.5yrs. Patients with AAV had a higher rate of ischaemic heart disease [HR 1.86 (1.62-2.15)], myocardial infarction [HR 1.62 (1.26-2.09)], coronary angiogram [HR 1.64 (1.37-1.96)], percutaneous coronary intervention [HR 1.56 (1.17-2.07)] and ventricular arrhythmias/implantable-cardioverter-defibrillator (ICD)-implantations [HR 2.04 (1.16-3.57)]. Similarly, an increased rate of heart failure [HR 2.12 (1.77-2.54)], deep vein thrombosis [HR 3.13 (2.43-4.05)], pulmonary embolism [HR 4.04 (3.07-5.32)], atrial fibrillation [HR 2.08 (1.82-2.39)], ischaemic stroke [HR 1.58 (1.31-1.90)] and in-hospital cardiac arrest [HR 2.27 (1.49-3.48)] was observed. The 5-year risk of all outcomes were significantly higher (excluding ventricular arrhythmia/ICD-implantations). For temporal trends among patients with AAV, a decreased 3-year risk of cardiovascular mortality was observed over time.

CONCLUSIONS

Patients with AAV are at increased risk of heart failure, atrial-/ventricular arrhythmias, venous thrombotic events, ischaemic stroke and myocardial infarction. Furthermore, patients with AAV were more frequently examined with coronary procedures and underwent more coronary revascularizations. No temporal changes in ischaemic cardiovascular outcomes were observed, albeit the cardiovascular mortality has decreased over time.

Wegener?s granulomatosis: Symptoms, diagnosis, and treatment

PURPOSE

To provide nurse practitioners with a basic understanding of the clinical presentation, diagnosis, diagnostic testing, pharmacological treatment, and prevalence of Wegener's granulomatosis (WG).

DATA SOURCES

Published research and clinical articles, and a case report.

CONCLUSIONS

WG is a systemic disease characterized by vasculitis, necrosis, and granulomas. The diagnosis of WG is difficult, particularly early in the disease process. In order to confirm the diagnosis, the patient should undergo specific tests such as antineutrophil cytoplasm antibodies, erythrocyte sedimentation rate, C-reactive protein, and biopsy of the tissue involved.

IMPLICATIONS FOR PRACTICE

The diagnosis of WG is often delayed because of the vague symptoms on presentation. Initial symptoms, such as chronic fatigue, upper respiratory infection, sinusitis, and otitis media are common and may not be alarming. Recognizing symptoms, ordering diagnostic tests, and providing appropriate pharmacological therapy is key to diagnosing and treating WG.