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Int J Cardiol. 2015 Nov 15;199:170-9. doi: 10.1016/j.ijcard.2015.06.087. Epub 2015 Jul 15.

Prevalence and prognostic relevance of cardiac involvement in ANCA-associated vasculitis: eosinophilic granulomatosis with polyangiitis and granulomatosis with polyangiitis.

Author information

1
Maastricht University Medical Centre, Department of Cardiology, Maastricht, The Netherlands.
2
CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands; Maastricht University Medical Centre, Department of Nephrology and Clinical Immunology, Internal Medicine, Maastricht, The Netherlands.
3
Maastricht University Medical Centre, Department of Radiology, Maastricht, The Netherlands.
4
Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven Belgium.
5
Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven Belgium; Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
6
Maastricht University Medical Centre, Department of Nephrology and Clinical Immunology, Internal Medicine, Maastricht, The Netherlands.
7
CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
8
Maastricht University Medical Centre, Department of Cardiology, Maastricht, The Netherlands. Electronic address: s.heymans@maastrichtuniversity.nl.

Abstract

BACKGROUND:

To investigate the prevalence and prognostic relevance of cardiac involvement in an ANCA-associated vasculitis (AAV) population of eosinophilic granulomatosis with polyangiitis (EGPA) and granulomatosis with polyangiitis (GPA) patients.

METHODS:

Prospective cohort study of fifty EGPA and forty-one GPA patients in sustained remission without previous in-depth cardiac screening attending our clinical immunology outpatient department. Cardiac screening included clinical evaluation, ECG, 24-hour Holter registration, echocardiography and cardiac magnetic resonance imaging (CMR) with coronary angiography and endomyocardial biopsy upon indication. Fifty age-, sex- and cardiovascular risk factor-matched control subjects were randomly selected from a population study. Long-term outcome was assessed using all-cause and cardiovascular mortality.

RESULTS:

A total of 91 AAV-patients (age 60±11, range 63-87years) were compared to 50-matched control subjects (age 60±9years, range 46-78years). ECG and echocardiography demonstrated cardiac abnormalities in 62% EGPA and 46% GPA patients vs 20% controls (P<0.001 and P=0.014, respectively). A total of 69 AAV-patients underwent additional CMR, slightly increasing the prevalence of cardiac involvement to 66% in EGPA and 61% in GPA patients. After a mean follow-up of 53±18months, presence of cardiac involvement using ECG and echocardiography in AAV-patients showed increased all-cause and cardiovascular mortality (Log-rank P=0.015 and Log-rank P=0.021, respectively).

CONCLUSION:

Cardiac involvement in EGPA and GPA patients with sustained remission is high, even if symptoms are absent and ECG is normal. Moreover, cardiac involvement is a strong predictor of (cardiovascular) mortality. Therefore, risk stratification using cardiac imaging is recommended in all AAV-patients, irrespective of symptoms or ECG abnormalities.

KEYWORDS:

Cardiovascular disease; Granulomatosis with polyangiitis; Prognosis; Systemic vasculitis

PMID:
26209947
DOI:
10.1016/j.ijcard.2015.06.087
[Indexed for MEDLINE]

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