Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Division of Rheumatology, Mayo Clinic, Rochester, MN, USA.
Clin Exp Rheumatol. 2018 Mar-Apr;36 Suppl 111(2):46-50. Epub 2017 Jun 12.
To evaluate cardiopulmonary (CP) involvement in patients with Takayasu's arteritis (TAK) and assess the impact on disease outcomes.
A retrospective cohort of patients with newly diagnosed TAK from 1984 to 2009 was assembled. Demographics, baseline disease characteristics, relapse events, surgeries and mortality were abstracted from direct medical record review. Angiograms, advanced imaging and cardiac studies were reviewed for evidence of CP involvement. Cox models with time-dependent covariates were used to assess the association between CP involvement and outcomes.
A total of 124 patients with TAK were identified. Forty-five (36%) patients had at least one objective CP abnormality observed within 6 months of TAK diagnosis. Age at diagnosis was higher in those with CP involvement than those without (34.6 vs 30.1 yrs; p=0.04). Baseline characteristics and symptoms were similar, except shortness of breath, which was more frequently observed at TAK diagnosis in patients with CP involvement compared to those without (53% vs 21%; p=0.001). Composite CP involvement was not associated with risk of first surgery [Hazard ratio (95% CI): 1.21 (0.64-2.30); p=0.56]. However, pulmonary hypertension (PH) on echocardiogram was significantly associated with risk of first surgery [HR (95% CI): 12.9 (1.86- 89.14); p=0.01]. CP involvement was not significantly associated with mortality [HR (95% CI): 2.51 (0.45- 14.02); p=0.29].
Cardiopulmonary abnormalities in TAK are common at the time of initial presentation. In this population, the presence of PH predicted a 13-fold increased risk for vascular or valvular surgery. In this cohort, the presence of CP involvement did not increase mortality.
评估 Takayasu 动脉炎（TAK）患者的心肺（CP）受累情况，并评估其对疾病结局的影响。
收集了 1984 年至 2009 年新诊断为 TAK 的患者的回顾性队列。从直接病历审查中提取人口统计学、基线疾病特征、复发事件、手术和死亡率。对血管造影、高级影像学和心脏研究进行审查，以评估 CP 受累的证据。使用具有时变协变量的 Cox 模型评估 CP 受累与结局之间的关联。
共确定了 124 例 TAK 患者。45 例（36%）患者在 TAK 诊断后 6 个月内至少有一项 CP 异常。CP 受累患者的诊断年龄高于无 CP 受累患者（34.6 岁比 30.1 岁；p=0.04）。基线特征和症状相似，但 CP 受累患者的呼吸困难更为常见，与无 CP 受累患者相比（53%比 21%；p=0.001）。复合 CP 受累与首次手术风险无关[危险比（95%CI）：1.21（0.64-2.30）；p=0.56]。然而，超声心动图上的肺动脉高压（PH）与首次手术风险显著相关[HR（95%CI）：12.9（1.86-89.14）；p=0.01]。CP 受累与死亡率无显著相关性[HR（95%CI）：2.51（0.45-14.02）；p=0.29]。
TAK 初始表现时 CP 异常很常见。在该人群中，PH 的存在预测血管或瓣膜手术的风险增加 13 倍。在本队列中，CP 受累的存在并未增加死亡率。
