Predictors of left ventricular dysfunction in patients with Takayasu's or giant cell aortitis

David H. Pfizenmaier, Faisal O. Al Atawi, Yamil Castillo, Krishnaswamy Chandrasekaran, Leslie T Jr. Cooper

Research output: Contribution to journalArticle

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Abstract

Objectives. The aim of this study was to determine the clinical and angiographic predictors of left ventricular systolic dysfunction (LVSD) from a relatively large and angiographically characterized Takayasu's or Giant Cell aortitis (TA/GCA) population. Background. LVSD in patients with TA/GCA has been described in case reports and attributed variously to hemodynamic and immunologic factors. The predictors of LVSD in patients with angiographically confirmed TA/GCA are not known. Methods. We identified 78 patients with angiographically confirmed TA/GCA that underwent transthoracic echocardiography (TTE) at Mayo Clinic. Echocardiograms were then reviewed independently by reviewers blinded to clinical and angiographic data. LVSD was defined as an ejection fraction (LVEF) less than 50%. Results. The study population was 84% Caucasian (54/78), 91% female (58/78), and had a mean age of disease onset of 30 years (±15 years). LVSD was present in 14 of 78 patients (18%) with TA/GCA. The mean LVEF in the LVSD group (n = 14) was 37% ± 7%, compared to an LVEF of 62% ± 6% (p < 0.0001) in those without LVSD (n = 64). LVSD was not associated with hypertension or aortic regurgitation (p > 0.5). However, LVSD was found in 43% (9/21) of patients with aortic arch involvement, versus only 9% (5/57) of patients without aortic arch involvement (p = 0.0013). Patients with LVSD had a median of 2 (range 1-4) involved aortic segments compared to a median of 1 (range 1-4) among those without LVSD (p = 0.013). Conclusions. In TA/GCA aortitis, LVSD is associated with involvement of the aortic arch and with the greater extent of aortic involvement. The hemodynamic variables, aortic regurgitation and systemic hypertension, were not associated with LVSD, consistent with reports that cardiac inflammation is responsible for LVSD in a majority of cases. Ours is the first study to estimate an incidence of LVSD in patients with TA/GCA aortitis, which was 18%.

Original languageEnglish (US)
JournalClinical and Experimental Rheumatology
Volume22
Issue number6 SUPPL.
StatePublished - 2004

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Giant Cell Arteritis
Left Ventricular Dysfunction
Thoracic Aorta
Aortitis
Hemodynamics
Aortic Valve Insufficiency
Immunologic Factors
Age of Onset
Population
Echocardiography

Keywords

  • Aortitis
  • Dilated cardiomyopathy
  • Giant cell arteritis
  • Myocarditis
  • Takayasu's arteritis

ASJC Scopus subject areas

  • Rheumatology
  • Immunology

Cite this

Predictors of left ventricular dysfunction in patients with Takayasu's or giant cell aortitis. / Pfizenmaier, David H.; Al Atawi, Faisal O.; Castillo, Yamil; Chandrasekaran, Krishnaswamy; Cooper, Leslie T Jr.

In: Clinical and Experimental Rheumatology, Vol. 22, No. 6 SUPPL., 2004.

Research output: Contribution to journalArticle

Pfizenmaier, David H. ; Al Atawi, Faisal O. ; Castillo, Yamil ; Chandrasekaran, Krishnaswamy ; Cooper, Leslie T Jr. / Predictors of left ventricular dysfunction in patients with Takayasu's or giant cell aortitis. In: Clinical and Experimental Rheumatology. 2004 ; Vol. 22, No. 6 SUPPL.
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abstract = "Objectives. The aim of this study was to determine the clinical and angiographic predictors of left ventricular systolic dysfunction (LVSD) from a relatively large and angiographically characterized Takayasu's or Giant Cell aortitis (TA/GCA) population. Background. LVSD in patients with TA/GCA has been described in case reports and attributed variously to hemodynamic and immunologic factors. The predictors of LVSD in patients with angiographically confirmed TA/GCA are not known. Methods. We identified 78 patients with angiographically confirmed TA/GCA that underwent transthoracic echocardiography (TTE) at Mayo Clinic. Echocardiograms were then reviewed independently by reviewers blinded to clinical and angiographic data. LVSD was defined as an ejection fraction (LVEF) less than 50{\%}. Results. The study population was 84{\%} Caucasian (54/78), 91{\%} female (58/78), and had a mean age of disease onset of 30 years (±15 years). LVSD was present in 14 of 78 patients (18{\%}) with TA/GCA. The mean LVEF in the LVSD group (n = 14) was 37{\%} ± 7{\%}, compared to an LVEF of 62{\%} ± 6{\%} (p < 0.0001) in those without LVSD (n = 64). LVSD was not associated with hypertension or aortic regurgitation (p > 0.5). However, LVSD was found in 43{\%} (9/21) of patients with aortic arch involvement, versus only 9{\%} (5/57) of patients without aortic arch involvement (p = 0.0013). Patients with LVSD had a median of 2 (range 1-4) involved aortic segments compared to a median of 1 (range 1-4) among those without LVSD (p = 0.013). Conclusions. In TA/GCA aortitis, LVSD is associated with involvement of the aortic arch and with the greater extent of aortic involvement. The hemodynamic variables, aortic regurgitation and systemic hypertension, were not associated with LVSD, consistent with reports that cardiac inflammation is responsible for LVSD in a majority of cases. Ours is the first study to estimate an incidence of LVSD in patients with TA/GCA aortitis, which was 18{\%}.",
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T1 - Predictors of left ventricular dysfunction in patients with Takayasu's or giant cell aortitis

AU - Pfizenmaier, David H.

AU - Al Atawi, Faisal O.

AU - Castillo, Yamil

AU - Chandrasekaran, Krishnaswamy

AU - Cooper, Leslie T Jr.

PY - 2004

Y1 - 2004

N2 - Objectives. The aim of this study was to determine the clinical and angiographic predictors of left ventricular systolic dysfunction (LVSD) from a relatively large and angiographically characterized Takayasu's or Giant Cell aortitis (TA/GCA) population. Background. LVSD in patients with TA/GCA has been described in case reports and attributed variously to hemodynamic and immunologic factors. The predictors of LVSD in patients with angiographically confirmed TA/GCA are not known. Methods. We identified 78 patients with angiographically confirmed TA/GCA that underwent transthoracic echocardiography (TTE) at Mayo Clinic. Echocardiograms were then reviewed independently by reviewers blinded to clinical and angiographic data. LVSD was defined as an ejection fraction (LVEF) less than 50%. Results. The study population was 84% Caucasian (54/78), 91% female (58/78), and had a mean age of disease onset of 30 years (±15 years). LVSD was present in 14 of 78 patients (18%) with TA/GCA. The mean LVEF in the LVSD group (n = 14) was 37% ± 7%, compared to an LVEF of 62% ± 6% (p < 0.0001) in those without LVSD (n = 64). LVSD was not associated with hypertension or aortic regurgitation (p > 0.5). However, LVSD was found in 43% (9/21) of patients with aortic arch involvement, versus only 9% (5/57) of patients without aortic arch involvement (p = 0.0013). Patients with LVSD had a median of 2 (range 1-4) involved aortic segments compared to a median of 1 (range 1-4) among those without LVSD (p = 0.013). Conclusions. In TA/GCA aortitis, LVSD is associated with involvement of the aortic arch and with the greater extent of aortic involvement. The hemodynamic variables, aortic regurgitation and systemic hypertension, were not associated with LVSD, consistent with reports that cardiac inflammation is responsible for LVSD in a majority of cases. Ours is the first study to estimate an incidence of LVSD in patients with TA/GCA aortitis, which was 18%.

AB - Objectives. The aim of this study was to determine the clinical and angiographic predictors of left ventricular systolic dysfunction (LVSD) from a relatively large and angiographically characterized Takayasu's or Giant Cell aortitis (TA/GCA) population. Background. LVSD in patients with TA/GCA has been described in case reports and attributed variously to hemodynamic and immunologic factors. The predictors of LVSD in patients with angiographically confirmed TA/GCA are not known. Methods. We identified 78 patients with angiographically confirmed TA/GCA that underwent transthoracic echocardiography (TTE) at Mayo Clinic. Echocardiograms were then reviewed independently by reviewers blinded to clinical and angiographic data. LVSD was defined as an ejection fraction (LVEF) less than 50%. Results. The study population was 84% Caucasian (54/78), 91% female (58/78), and had a mean age of disease onset of 30 years (±15 years). LVSD was present in 14 of 78 patients (18%) with TA/GCA. The mean LVEF in the LVSD group (n = 14) was 37% ± 7%, compared to an LVEF of 62% ± 6% (p < 0.0001) in those without LVSD (n = 64). LVSD was not associated with hypertension or aortic regurgitation (p > 0.5). However, LVSD was found in 43% (9/21) of patients with aortic arch involvement, versus only 9% (5/57) of patients without aortic arch involvement (p = 0.0013). Patients with LVSD had a median of 2 (range 1-4) involved aortic segments compared to a median of 1 (range 1-4) among those without LVSD (p = 0.013). Conclusions. In TA/GCA aortitis, LVSD is associated with involvement of the aortic arch and with the greater extent of aortic involvement. The hemodynamic variables, aortic regurgitation and systemic hypertension, were not associated with LVSD, consistent with reports that cardiac inflammation is responsible for LVSD in a majority of cases. Ours is the first study to estimate an incidence of LVSD in patients with TA/GCA aortitis, which was 18%.

KW - Aortitis

KW - Dilated cardiomyopathy

KW - Giant cell arteritis

KW - Myocarditis

KW - Takayasu's arteritis

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C2 - 15675134

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JF - Clinical and Experimental Rheumatology

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