Predictors of cardiovascular complications in patients with Takayasu’s arteritis: results of a retrospective study and analysis of autopsy materials

Aim. To assess the effect of late diagnosis on survival and risk of vascular complications in Takayasu's arteritis (TA) patients. Methods. 183 patients with TA who were treated at the Sverdlovsk Regional Clinical Hospital No. 1 during the period from 01.01.1979 to 31.04.2018 were examined. There were 139 women and 44 men included, median age at the time of diagnosis being 35 [24; 44] years in females and 34 [26.5; 42] years in males and a median interval from the first symptoms onset to the diagnosis of 3 [1; 7] and 4 [1.5; 8] years respectively. The diagnosis of TA met the ACR criteria (1990).Results. During the follow-up period, 31 deaths were observed (18 in males and 13 in females). The median age of death for women was 36 [32-44] years, for men - 50 [40-57] years. Cardiovascular complications were recorded in 72 patients (27 men and 45 women). Vascular complications and namely acute cerebrovascular accident observed in 31 (43%) patients, including ischemic stroke in 24 (35%), transient ischemic attack in 3 (3%) and hemorrhagic stroke in 4 (6%) were the most frequent. Arterial thromboses were registered in 32 (44%) cases. In 162 (88.5%) patients, the diagnosis was established more than six months after the appearance of the first symptoms.At the primary physician visit in 71 (39%) patients, the initial diagnosis was erroneous. The most common symptoms they had were regarded as a manifestation of arterial hypertension (in 18% cases). 4 years or more interval from the onset of TA symptoms to diagnosis was associated with a significant cardiovascular events odds increase (OR=1.8; 95% CI: 1.07-3.34) and premature death by the 5th year of follow-up (OR=2.9; 95% CI: 1,27-6,55).Conclusion. In the retrospective TA cohort setting, late diagnosis verification and delayed treatment initiation were associated with an increased risk of premature death and severe vascular complications, described earlier in other samplings. Timely diagnosis and as early as possible appropriate treatment administration can prevent the disease progression and disabling complications occurrence.

Download Full-text

AB0487 TAKAYASU’S ARTERITIS: RECOGNIZING AN OLD ENEMY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.6605 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1541.2-1541

Author(s):

F. Torres ◽

D. Jaramillo Arroyave ◽

C. Muñoz ◽

L. Hernandez ◽

G. Vásquez ◽

...

Keyword(s):

Blood Pressure ◽

Retrospective Study ◽

Physical Examination ◽

Takayasu Arteritis ◽

Takayasu’S Arteritis ◽

Pulmonary Arteries ◽

Secondary Source ◽

Type I ◽

Takayasu's Arteritis ◽

Initial Symptoms

Background:Takayasu’s arteritis (AT) is a systemic vasculitis that affects large vessels, mainly the aorta, its branches and the pulmonary arteries. There are few data on their behavior in our region.Objectives:to describe the clinical and angiographic characteristics and outcomes of a group of patients with AT.Methods:a cross-sectional, retrospective study based on a secondary source taken from two high complexity hospitals in Medellin - Colombia between August 2011 and December 2018.Results:medical records of 41 patients were evaluated, 87.5% met the 1990 ACR criteria of AT. The majority were women (95.1%), with a median age at the time of diagnosis of 22 years (IR 52), 11 patients (26.8%) were over 40 years old at debut. The median delay in diagnosis was 12 months (IR: 167). Systemic symptoms included general malaise (29.3%), weight loss (29.3%) and fever (19.5%); the main vascular manifestations were hypertension and blood pressure difference (61%), headache (39%), upper limb claudication (31.7%), dyspnea (29.3%), angina (26.8%) and carotidinia (22%). Most frequent findings on physical examination were pulse absence or decrease (78%) and subclavian murmur (53.7%). ESR and CRP were found high in 85.3% and 22%, respectively. Angiographic studies revealed stenosis or occlusion in multiple arterial territories, being the stenosis of the left subclavian artery the most frequent lesion (68.3%), followed by the involvement of the abdominal aorta (58.5%) and thoracic (51%). The distribution according to Hata-Numano classification was: type V (58.5%), type I (17.1%) and type IIa (7.3%), indicating complex vascular lesions and associated serious complications. Abnormalities of the renal arteries, pulmonary arteries involvement, and aortic insufficiency were present in 39%, 14.6%, and 7.3% respectively. Seventy-five percent of patients had active disease, glucocorticoids were the main treatment in 90.2% of the cases, used isolated (2.4%) or in combination with other immunosuppressants (87.8%), including methotrexate (75.6%), azathioprine (26.8%) and cyclophosphamide (14.6%); vascular interventions were performed in 11 patients (26.8%). Most relevant vascular complications were renovascular hypertension (26.8%), stroke (19.5%), chronic kidney disease (19.5%) and chronic heart failure (17.1%). From the clinical point of view, our findings were similar to those shown in series from Brazil, Japan, and Turkey. Contrary to what was reported in other series, carotidinia was a finding that occurred in almost a quarter of our patients (23%) and maybe one of the initial symptoms of the disease. The findings of the vascular physical examination are similar to those reported by the IRAVAS group, where the asymmetry of the pulses was most frequent, followed by the presence of murmurs and the difference in blood pressure, claudication being less frequent in the upper and lower limbs.Conclusion:patients in this series are characterized by having an extensive disease partly due to a late diagnosis, with a high percentage of complications associated with vascular stenotic compromise, which generates morbidity and impact on the quality of life.References:[1]Sato EI, et al. Takayasu arteritis. Treatment and prognosis in a university center in Brazil, Int J Cardiol. 2000; 75 Suppl 1: S163-6.[2]Arnaud L, et al. Takayasu arteritis in France: a single-center retrospective study of 82 cases comparing white, North African, and black patients. Medicine (Baltimore). 2010; 89(1): 1-17.Disclosure of Interests: :None declared

Download Full-text

Histological verification of non-specific aorta-arteritis (Takayasu's arteritis) using percutaneous transluminal atherectomy

VASA ◽

10.1024/0301-1526.33.4.247 ◽

2004 ◽

Vol 33 (4) ◽

pp. 247-251 ◽

Cited By ~ 6

Author(s):

Zeller ◽

Koch ◽

Frank ◽

Bürgelin ◽

Schwarzwälder ◽

...

Keyword(s):

Clinical Diagnosis ◽

Axillary Artery ◽

Takayasu’S Arteritis ◽

Giant Cells ◽

Interventional Therapy ◽

Takayasu's Arteritis ◽

New Device ◽

First Case ◽

Anti Inflammatory ◽

Percutaneous Transluminal

Diagnosis of non-specific aorto-arteritis (NSAA, Takaysu's arteritis) is typically based on clinical and investigational parameters. We report here about two patients with clinically suspected diagnosis of a Takayasu's arteritis already under anti-inflammatory therapy in whom percutaneous transluminal atherectomy of subclavian and axillary artery stenoses was performed to relief the patients from symptoms – intermittent dyspraxia of the arms – and to verify the clinical diagnosis by histology. In the first case aorto-arteritis could be histologically confirmed through the analysis of plaque material including media structures excised from the subclavian and axillary arteries using a new device for atherectomy. The biopsy showed diffuse inflammation and granulomatous lesions with giant cells typically for Takayasu's disease. In the second patient, biopsy showed no acute or chronic inflammatory signs but only atherosclerotic lesions. Percutaneous transluminal atherectomy is therefore not only an interventional but also a diagnostic tool and should be used in every case of interventional therapy of suspected aorto-arteritis to make the clinical diagnosis and as a major consequence the initiation of an aggressive anti-inflammatory medical therapy more reliable.

Download Full-text