Hendrickson Michael, Parakh Anushri, Weber Brittany, Cook Claire, Ahola Catherine, Hedgire Sandeep, Lu Michael, Wallace Zachary S
Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.
RMD Open. 2025 Jan 6;11(1):e004774. doi: 10.1136/rmdopen-2024-004774.
Cardiovascular disease (CVD) is a leading cause of death in ANCA-associated vasculitis (AAV). Screening and primary cardiovascular prevention may improve outcomes.
We identified patients in the 2002-2019 Mass General Brigham AAV cohort with thoracic CT scans obtained for other clinical purposes. Coronary artery calcium (CAC) scores and age, sex and race-standardised CAC percentiles were calculated. Quantile regression was used to identify differences by ANCA type, and Gray's test examined differences in major adverse cardiac events by CAC score.
Of 175 included patients, 127 (73%) were MPO-ANCA+and 48 (27%) were PR3-ANCA+. The median CAC score was 17 (IQR 0, 334) and CAC percentile was 45 (IQR 0, 78); 65 (39%) patients had CAC of ≥100. The total CAC score was higher in patients with MPO-ANCA+AAV vs PR3-ANCA+AAV (median 24 vs 1, p=0.003), as was the standardised CAC percentile (50th vs 34th, p=0.02). Of 116 (66%) patients with non-zero CAC scores, only 29 (25%) were on a statin. In a time-to-event analysis, CAC of 100 or higher trended towards association with higher risk of major adverse cardiovascular events (χ=1.9, p=0.16).
A majority of patients with AAV had clinically significant CAC. There were differences in CAC burden among those with MPO-ANCA+AAV versus PR3-ANCA+AAV. Although CAC is associated with CVD risk and an indication for statins, the use was inconsistent. The role of CT imaging to screen for CVD and guide primary prevention in AAV requires further study.
心血管疾病（CVD）是抗中性粒细胞胞浆抗体相关性血管炎（AAV）的主要死因。筛查和一级心血管预防可能改善预后。
我们在2002年至2019年麻省总医院布莱根分院的AAV队列中，识别出因其他临床目的进行胸部CT扫描的患者。计算冠状动脉钙化（CAC）评分以及年龄、性别和种族标准化的CAC百分位数。采用分位数回归确定不同抗中性粒细胞胞浆抗体类型之间的差异，并用Gray检验检查不同CAC评分患者主要不良心脏事件的差异。
纳入的175例患者中，127例（73%）为髓过氧化物酶抗中性粒细胞胞浆抗体阳性（MPO-ANCA+），48例（27%）为蛋白酶3抗中性粒细胞胞浆抗体阳性（PR3-ANCA+）。CAC评分中位数为17（四分位间距0，334），CAC百分位数为45（四分位间距0，78）；65例（39%）患者的CAC≥100。MPO-ANCA+AAV患者的总CAC评分高于PR3-ANCA+AAV患者（中位数24对1，p=0.003），标准化CAC百分位数也是如此（第50百分位对第34百分位，p=0.02）。在116例（66%）CAC评分非零的患者中，只有29例（25%）服用他汀类药物。在一项事件发生时间分析中，CAC为100或更高与主要不良心血管事件风险增加呈趋势性关联（χ=1.9，p=0.16）。
大多数AAV患者有临床显著的CAC。MPO-ANCA+AAV患者与PR3-ANCA+AAV患者的CAC负担存在差异。虽然CAC与CVD风险相关且是使用他汀类药物的指征，但使用情况并不一致。CT成像在AAV中筛查CVD和指导一级预防的作用需要进一步研究。
