Binzenhöfer Leonhard, Strauß Katharina, Seifert Linus, Saleh Inas, Scherzer Marie, Höpler Julia, Gailis Didzis, Gebhard Christina, Lichtnekert Julia, Ullrich Fabian, Singh Delila, Sonneck Torben, Thaler Matthias, Zimmer Sebastian, Massberg Steffen, Thiele Holger, Schäfer Valentin Sebastian, Nickenig Georg, Czihal Michael, Schulze-Koops Hendrik, Lüsebrink Enzo
Medizinische Klinik Und Poliklinik I, Munich, Germany and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Klinikum Der Universität München, Munich, Germany.
Institute of Medical Information Processing, Biometry and Epidemiology and Department of Statistics, Ludwig-Maximilians Universität München, Munich, Germany.
Clin Res Cardiol. 2025 Aug 25. doi: 10.1007/s00392-025-02728-y.
Cardiac involvement has been described in many forms of vasculitides and is associated with worse outcomes. However, data on the incidence of structural and arrhythmic heart disease is limited.
For this single-center study, we recruited 191 patients with giant-cell arteritis (GCA, n = 109), Takayasu arteritis (TAK, n = 26), polyarteritis nodosa (PAN, n = 3), granulomatosis with polyangiitis (GPA, n = 38), or eosinophilic granulomatosis with polyangiitis (EGPA, n = 15) between August 2023 and January 2025. The primary study endpoint was the incidence of structural or arrhythmic heart disease after the diagnosis of vasculitis.
The demographic characteristics of patients diagnosed with vasculitis differed significantly between those with GCA, TAK, PAN, GPA, and EGPA. Arterial hypertension and dyslipidemia at baseline were more prevalent among patients with GCA, while chest pain and signs of congestion were more frequently reported by patients with EGPA. No significant difference between the five main subgroups were found regarding the incidence of documented arrhythmic diseases. Cardiac imaging was performed using echocardiography in 70% of the overall cohort and cardiac magnetic resonance (CMR) in 11%. CMR detected left ventricular systolic dysfunction and myocardial fibrosis in 33% and 40% of EGPA patients, respectively. All four cases of acute myocardial infarction occurred in patients with GCA. Among 19 GCA patients who underwent coronary angiography, 21.1% underwent percutaneous coronary intervention. In the EGPA group, coronary angiography was performed in 46.7% of patients, but none required percutaneous intervention. A substantial proportion of patients was treated with acetylsalicylic acid (50.3%), beta-blockers (41.9%), or ACE-inhibitors/AT1-receptor antagonists (60.2%).
Severe cardiac complications occurred rarely, although cardiovascular risk factors, structural abnormalities, and arrhythmias affected a substantial proportion of patients with vasculitis, highlighting the potential benefit of systematic screening and multidisciplinary management.
心脏受累在多种血管炎中均有描述，且与较差的预后相关。然而，关于结构性和心律失常性心脏病发病率的数据有限。
在这项单中心研究中，我们在2023年8月至2025年1月期间招募了191例巨细胞动脉炎（GCA，n = 109）、大动脉炎（TAK，n = 26）、结节性多动脉炎（PAN，n = 3）、肉芽肿性多血管炎（GPA，n = 38）或嗜酸性肉芽肿性多血管炎（EGPA，n = 15）患者。主要研究终点是血管炎诊断后结构性或心律失常性心脏病的发病率。
诊断为血管炎的患者的人口统计学特征在GCA、TAK、PAN、GPA和EGPA患者之间存在显著差异。基线时动脉高血压和血脂异常在GCA患者中更为普遍，而EGPA患者更常报告胸痛和充血体征。在记录的心律失常性疾病发病率方面，五个主要亚组之间未发现显著差异。在整个队列中，70%的患者使用超声心动图进行心脏成像，11%的患者使用心脏磁共振（CMR）。CMR分别在33%和40%的EGPA患者中检测到左心室收缩功能障碍和心肌纤维化。所有4例急性心肌梗死均发生在GCA患者中。在19例接受冠状动脉造影的GCA患者中，21.1%接受了经皮冠状动脉介入治疗。在EGPA组中，46.7%的患者进行了冠状动脉造影，但无一例需要经皮介入治疗。相当一部分患者接受了阿司匹林（50.3%）、β受体阻滞剂（41.9%）或ACE抑制剂/AT1受体拮抗剂（60.2%）治疗。
严重心脏并发症很少发生，尽管心血管危险因素、结构异常和心律失常影响了相当一部分血管炎患者，这突出了系统筛查和多学科管理的潜在益处。
