Characteristics of Takayasu Arteritis Patients with Severe Ischemic Events

Abstract

Objective Takayasu arteritis (TA) is a rare large-vessel vasculitis that puts patients at high risk of developing severe ischemic events (SIE). Outcomes for TA patients with SIE are poorly understood. We aim to describe the characteristics of TA patients experiencing SIE. Methods All TA patients with at least 1 followup visit seen between 1988 and 2015 were included from 3 academic centers in Ontario, Canada. Diagnosis was based on American College of Rheumatology criteria, physician opinion, and vascular imaging. SIE were defined as cerebrovascular accident (CVA), acute coronary syndrome (ACS), ischemic cardiomyopathy, ischemic blindness, and/or ischemic bowel or limb requiring surgery. Results Of the 52 patients with TA included in the study, 51 (98%) were female and 22 (42%) were of European descent. The mean age was 31 (SD 12) at the time of diagnosis and the followup time was 6 years (SD 5). Fifteen (29%) experienced an SIE: 5 CVA, 5 ACS, 1 ischemic cardiomyopathy, and 4 limb ischemia. Thirteen out of 15 SIE (87%) occurred at or before diagnosis. Patients with SIE were more likely than those without SIE to be started on corticosteroids combined with immunosuppressants (p = 0.04) and antiplatelet agents (p = 0.004). Outcomes including disease activity and damage scores were similar between patients with and without SIE. Conclusion SIE are common in patients with TA and occur early in the disease. With aggressive treatment, patients with SIE had a favorable prognosis.

Myocardial and Vascular Involvement in Patients with Takayasu Arteritis: A Cardiovascular MRI Study

“…Interestingly, our results revealed no significant difference in the mean ESR level between TA patients with and without MACCEs during the follow-up period, nor was there any significant association between corticosteroid dose (high-dose vs. low-dose) and the occurrence of MACCEs. A recent study conducted by Yu et al [36] on 52 TA patients, reported that 15 (29%) of these patients experienced a severe ischemic event (ISE) within the 6-year follow-up period, of which 5 experienced CVA, 5 encountered acute coronary syndrome (ACS), 1 exhibited ischemic cardiomyopathy, and 5 experienced limb ischemia. They further investigated the potential predictors of ISE in TA patients.…”