Mavrogeni S, Manoussakis M N, Karagiorga T C, Douskou M, Panagiotakos D, Bournia V, Cokkinos D V, Moutsopoulos H M
Onassis Cardiac Surgery Center, Athens, Greece.
Arthritis Rheum. 2009 Aug 15;61(8):1121-9. doi: 10.1002/art.24695.
Myocardium and coronary arteries can occasionally be affected in patients with systemic necrotizing vasculitides; however, such involvement has not been systematically assessed using cardiovascular magnetic resonance imaging (MRI).
Magnetic resonance angiography and contrast-enhanced MRI were applied for the assessment of coronary arteries (the left anterior descending [LAD], left circumflex [LCx], and right coronary artery [RCA]) and myocardium, respectively, in 39 patients with vasculitis who were asymptomatic for cardiac disease (16 with microscopic polyangiitis [MPA], 11 with Wegener's granulomatosis [WG], 9 with Churg-Strauss syndrome [CSS], and 3 with polyarteritis nodosa [PAN]). Data were compared with age-matched disease-control patients with rheumatoid arthritis (n = 20) or systemic lupus erythematosus (n = 13), and with healthy control individuals with normal coronaries (n = 40).
Patients with MPA, WG, and PAN (but not with CSS) were found to display significantly increased maximal diameters of coronary arteries compared with healthy controls (for MPA and WG; P < 0.001 for LAD and RCA, and P < 0.01 for LCx) and with both disease-control groups (for only MPA; P < 0.01 for LAD and RCA, and P < 0.05 for LCx). Fusiform coronary aneurysms were detected in patients with MPA (4/16) and PAN (2/3), whereas coronary ectasias were evident in patients with MPA (14/16) and WG (2/11). The presence of myocardial necrosis (by assessment of late gadolinium-enhanced images) was identified only in patients with MPA (2/16) and CSS (3/8 studied).
Cardiovascular MRI assessment of patients with systemic vasculitis revealed coronary ectatic disease in the majority of patients with MPA and PAN, as well as in several patients with WG. Myocardial necrosis can be detected in MPA and CSS.
系统性坏死性血管炎患者的心肌和冠状动脉偶尔会受到影响；然而，尚未使用心血管磁共振成像（MRI）对这种累及情况进行系统评估。
对39例无心脏病症状的血管炎患者（16例显微镜下多血管炎[MPA]、11例韦格纳肉芽肿病[WG]、9例变应性肉芽肿性血管炎[CSS]和3例结节性多动脉炎[PAN]）分别应用磁共振血管造影和对比增强MRI评估冠状动脉（左前降支[LAD]、左旋支[LCx]和右冠状动脉[RCA]）和心肌。将数据与年龄匹配的类风湿关节炎疾病对照患者（n = 20）或系统性红斑狼疮患者（n = 13）以及冠状动脉正常的健康对照个体（n = 40）进行比较。
发现MPA、WG和PAN患者（但CSS患者未出现）与健康对照相比，冠状动脉最大直径显著增加（MPA和WG患者；LAD和RCA的P < 0.001，LCx的P < 0.01），与两个疾病对照组相比也增加（仅MPA患者；LAD和RCA的P < 0.01，LCx的P < 0.05）。在MPA患者（4/16）和PAN患者（2/3）中检测到梭形冠状动脉瘤，而在MPA患者（14/16）和WG患者（2/11）中可见冠状动脉扩张。仅在MPA患者（2/16）和CSS患者（8例中的3例）中通过延迟钆增强图像评估发现存在心肌坏死。
对系统性血管炎患者进行心血管MRI评估发现，大多数MPA和PAN患者以及部分WG患者存在冠状动脉扩张性疾病。在MPA和CSS中可检测到心肌坏死。
