Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India.
Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India.
Indian Heart J. 2022 Mar-Apr;74(2):139-143. doi: 10.1016/j.ihj.2022.02.004. Epub 2022 Feb 23.
Overt left ventricular (LV) dysfunction and congestive heart failure are known entities in Takayasu arteritis (TA). Subclinical LV dysfunction may develop in these patients despite normal LV ejection fraction (LVEF). Moreover, effect of treatment of aortic or renal artery narrowing in such patients is unknown.
This study included 15 angiographically confirmed TA patients undergoing aortic and/or renal intervention. A comprehensive clinical, biochemical and echocardiographic (2-dimensional, speckle tracking and tissue doppler imaging) evaluation were done at baseline, 72 h, and six months post intervention.
Six patients (40%) had reduced LVEF (<50%) at baseline while rest 9 (60%) patients had reduced global longitudinal strain (GLS) but normal EF. Diastolic filling pattern was abnormal in all the patients. In patients with baseline reduced EF, mean EF improved from 24.62 ± 12.14% to 45.6 ± 9.45% (p = 0.001), E/e' ratio decreased from 15.15 ± 3.19 to 10.8 ± 2.56 (p = 0.005) and median NT pro BNP decreased from 1673 pg/ml (970-2401 pg/ml) to 80 pg/ml (40-354 pg/ml) (p = 0.001) at 6 months after interventional procedure. In patients with baseline normal EF, median NT pro BNP decreased from 512 pg/ml (80-898.5 pg/ml) to 34 pg/ml (29-70.8 pg/ml) (p < 0.01), mean GLS improved from -8.80 ± 0.77% to -16.3 ± 0.78% (p < 0.001) and mean E/e' decreased from 12.93 ± 2.63 to 7.8 ± 2.73 (p = 0.005) at 6 months follow up.
LV dysfunction is common in patients with TA and obstructive lesions in aorta or renal arteries. GLS can be used to assess subclinical systolic dysfunction in these patients. Timely intervention can improve LV dysfunction and can even reverse the subclinical changes.
巨细胞动脉炎（TA）已知会导致左心室（LV）功能障碍和充血性心力衰竭。尽管左心室射血分数（LVEF）正常，但这些患者可能会出现亚临床 LV 功能障碍。此外，尚不清楚此类患者的主动脉或肾动脉狭窄治疗效果如何。
本研究纳入了 15 名经血管造影证实的接受主动脉和/或肾动脉介入治疗的 TA 患者。在基线、72 小时和介入治疗后 6 个月进行全面的临床、生化和超声心动图（二维、斑点追踪和组织多普勒成像）评估。
6 名患者（40%）在基线时存在 LVEF 降低（<50%），而其余 9 名患者（60%）存在整体纵向应变（GLS）降低，但 EF 正常。所有患者的舒张充盈模式均异常。在基线时 EF 降低的患者中，平均 EF 从 24.62±12.14%改善至 45.6±9.45%（p=0.001），E/e' 比值从 15.15±3.19 降至 10.8±2.56（p=0.005），中位数 NT pro BNP 从 1673pg/ml（970-2401pg/ml）降至 80pg/ml（40-354pg/ml）（p=0.001）。在基线 EF 正常的患者中，中位数 NT pro BNP 从 512pg/ml（80-898.5pg/ml）降至 34pg/ml（29-70.8pg/ml）（p<0.01），平均 GLS 从-8.80±0.77%改善至-16.3±0.78%（p<0.001），平均 E/e'从 12.93±2.63 降至 7.8±2.73（p=0.005）。
TA 患者伴主动脉或肾动脉阻塞性病变时 LV 功能障碍常见。GLS 可用于评估这些患者的亚临床收缩功能障碍。及时干预可改善 LV 功能障碍，甚至可逆转亚临床变化。
