Risk factors for the adverse cardiac outcomes in the patients with Takayasu’s arteritis.

Abstract

Background : This study was aimed to investigate the long-term cardiac outcomes and find out risk factors for the deterioration of cardiac structure and function in patients with Takayasu’s arteritis (TAK).Methods : One hundred and ninety-eight TAK patients were recruited in the Department of Rheumatology, Zhongshan Hospital, Fudan University from January 2012 to December 2017. The endpoint of observation was December 31, 2019. Patients were divided into normal, mild-moderate and severe subgroups based on the severity of structural and functional impairment of heart. Comparison of baseline characteristics and treatment among these three subgroups was conducted to identify the risk factors for adverse cardiac outcomes.Results : A total of 60.1% (119/198) of TAK patients exhibited heart involvement on echocardiography at baseline. 70.6% (84/119) and 79.8% (95/119) cases showed pathological valvular and atrioventricular abnormalities, respectively. 68.7% (136/198) of patients were followed up and the median follow-up duration was 28.6 (12.3-43.4) months. 42.7% (58/136) and 22.8% (31/136) of patients had progress in heart’s structure and function. Cox regression showed that serum TNF-α level (HR=1.028, p= 0.021), aortic regurgitation (HR=3.109, p<0.001) and ventricular hypertrophy (HR=2.090, p= 0.006) at baseline were risk factors for the deterioration of cardiac structure. The cases with serum TNF-α levels (≥8.1pg/ml), mild aortic regurgitation and ventricular hypertrophy at baseline had highest risk of structural progression at 83.4%. Using normal subgroup as a control, the deterioration of cardiac structure and function was the most severe in the severe subgroup, with hazard ratios of 16.2 (95% CI, 6.0-44.1, p < 0.001) and 9.0 (95% CI, 3.3-24.5, p<0.001), respectively. The deteriorating events typically occurred within 2 years after diagnosis.Conclusions : To find out if there is heart involvement and progress, it’s indispensable to regularly monitor the serum TNF-α level and cardiac structure in TAK patients during the long-term follow-up.