IgG4-related disease of the mitral valve demonstrated by immunohistochemistry

Tiong, Benedict K.; Fishbein, Gregory A.; Brahn, Ernest

doi:10.1136/annrheumdis-2018-213042

Cited by 3 publications

(2 citation statements)

References 7 publications

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“…The most frequently reported cardiovascular presentations were aortitis (causing aortic aneurysms) [ 15 , 29 , 30 , 31 ] and pericarditis [ 32 , 33 , 34 , 35 , 36 , 37 ]. Subsequently, other forms of cardiovascular presentations were reported, such as valvular disease [ 18 , 38 , 39 , 40 , 41 , 42 ], heart block [ 18 , 43 ], and an involvement of heart chambers and coronary vessels with IgG4-related inflammatory pseudotumors [ 44 , 45 , 46 , 47 ]. Coronary artery involvement caused by coronary periarteritis with aneurysms and inflammatory pseudotumors surrounding and compressing the vessels [ 20 , 48 , 49 , 50 , 51 ] with subsequent stenosis or obstruction and ischemia have also been reported.…”

Section: Discussionmentioning

confidence: 99%

Elevated Serum Levels of IgG4 in Patients with Heart Failure with Reduced Ejection Fraction: A Prospective Controlled Study

Volodarsky

Anton

Zilberman

et al. 2022

Biology

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(1) Background: Immunoglobulin gamma subclass 4 (IgG4) is a serum protein belonging to the immunoglobulin superfamily. It has a central role in certain immune-mediated conditions defined as IgG4-related disease. There is a paucity of data regarding the potential association of IgG4 and cardiovascular diseases. Our aim is to study the serum levels of IgG4 in patients with ischemic and non-ischemic dilated cardiomyopathy (DCM). (2) Methods: patients with ischemic and non-ischemic DCM were included in this study. Non-ischemic DCM was defined as a left ventricular ejection fraction (LVEF) < 40% without coronary artery disease (CAD). Ischemic DCM was defined as a LVEF < 40% and proven CAD. The serum concentrations of IgG4 were measured by turbidimetry. (3) Results: Overall 98 patients with cardiomyopathy had significantly higher levels of IgG4 compared with the control group (77.4 ± 64.0 vs. 50.3 ± 28.8 mg/dL, p < 0.01). Although there was no difference in the total IgG levels in patients with ischemic DCM, the serum concentrations of IgG4 were significantly higher than the corresponding values in the control group (89.8 ± 67.3 vs. 50.3 ± 28.8 mg/dL; interquartile ranges: 40.4–126.5 vs. 31.8–66.8 mg/dL, p < 0.01). This was altered by gender and smoking. (4) Conclusions: The patients with ischemic DCM had increased serum concentrations of IgG4. Future studies are warranted to explore the potential role of an IgG4-mediated process in patients with heart failure with reduced LVEF.

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Section: Discussionmentioning

confidence: 99%

Elevated Serum Levels of IgG4 in Patients with Heart Failure with Reduced Ejection Fraction: A Prospective Controlled Study

Volodarsky

Anton

Zilberman

et al. 2022

Biology

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“…Increasing numbers of case report or case series show that IgG4-related disease may target cardiovascular organs, including aorta, peripheral arteries, pericardium, and cardiac valves. [1][2][3][4][5] On the other hand, when making definitive diagnosis of IgG4related disease, histopathological confirmation is required, especially when using comprehensive diagnostic criteria (CDC). 6) Diagnosing IgG4-related disease is, however, often difficult due to non-negligible risk of tissue sampling and scattered distribution of inflamed areas.…”

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confidence: 99%

IgG4-Positive Plasmacytic Infiltration in Aortic Wall and Aortic Valve Surgical Samples and Its Relation to Preoperative Serum IgG4 Levels

et al. 2019

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The prevalence and extent of immunoglobulin G4 (IgG4)-positive cell infiltration were investigated in 282 surgical samples of aortic wall and aortic valve. Tissue infiltration of IgG4-positive cells was observed in 24 (17.3%) of 139 aortic valve samples and 46 (32%) of 143 aortic wall samples, and the condition of IgG4positive cell infiltration > 30/hpf together with IgG4/CD138 ratio > 40% was observed in 2 (1.4%) of aortic valve samples and 14 (9.8%) of aortic wall samples. Among 275 patients, preoperative serum IgG4 level was available in 48 patients (50 samples), and it was > 135 mg/dL in only one patient. Of these 48 patients with serum IgG4 measurement, 29 patients had aortic valve stenosis and 12 had aortic aneurysm. Compared with 23 aortic stenosis patients without tissue infiltration of IgG4-positive cells in the aortic valve, six patients with IgG 4-positive cell infiltration had a more prevalent smoking history (26% versus 83%) and borderline significantly higher serum IgG4 (median, 24.5 mg/dL versus 55.5 mg/dL), although either preoperative peak pressure gradient between left ventriculum and aorta or aortic valve area did not differ significantly between groups. Compared with six aortic aneurysm patients without tissue infiltration of IgG4-positive cells in the aortic wall, six patients with IgG4-positive cell infiltration had borderline significantly higher serum IgG4 (median, 28.9 mg/dL versus 68.2 mg/dL). The current study showed that tissue IgG4-positive infiltration is not a rare occurrence in the aortic stenosis and aortic aneurysm. Clinical significance of tissue IgG4-postive cell infiltration in these patients requires further investigation.

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IgG4-related disease of the mitral and aortic valves presenting as rapid, recurrent prosthetic valve failure

et al. 2020

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IgG4-related disease of the mitral valve demonstrated by immunohistochemistry

Cited by 3 publications

References 7 publications

Elevated Serum Levels of IgG4 in Patients with Heart Failure with Reduced Ejection Fraction: A Prospective Controlled Study

Elevated Serum Levels of IgG4 in Patients with Heart Failure with Reduced Ejection Fraction: A Prospective Controlled Study

IgG4-Positive Plasmacytic Infiltration in Aortic Wall and Aortic Valve Surgical Samples and Its Relation to Preoperative Serum IgG4 Levels

IgG4-related disease of the mitral and aortic valves presenting as rapid, recurrent prosthetic valve failure

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