Management of cardiac manifestations in Takayasu arteritis

Abstract

Takayasu arteritis (TA) is a chronic vasculitis involving large vessels of unknown aetiology, a disease that is more common among the Asian population and predominant in young women. Cardiac manifestations include hypertension and involvement of the cardiac valves, myocardium and coronary arteries. Surgery on these patients is always a challenge given the tissue quality and the disease activity. They are prone to long-term complications such as restenosis and graft occlusion, hence requiring lifelong surveillance. The prevalence of coronary artery disease (CAD) in TA ranges from 9 to 11%. Coronary artery bypass grafting is preferred to percutaneous coronary intervention, as the latter has a high rate of restenosis and major adverse cardiovascular events. As left subclavian artery is commonly involved, saphenous vein graft is advised as a conduit rather than internal mammary artery. Other surgical procedures described for CAD are surgical angioplasty of the left main coronary artery and transaortic coronary ostial endarterectomy. Aortic regurgitation in TA has an incidence of approximately 20%. These patients tend to have prosthetic valve detachment, paravalvular leak or pseudoaneurysm at the anastomotic site. Further repair of these valves have a high rate of failure. Considering these facts, it is advisable to do an aortic root replacement for TA patients than to consider an aortic valve replacement or David's procedure.

Keywords

Takayasu arteritis / coronary artery / aortic valve / myocarditis / ascending aorta / aortoarteritis / pulmonary arteritis

References

[1] Zaldivar Villon MLF,Espinoza LR.Takayasu arteritis: recent developments..Curr Rheumatol Rep2019;21:45

[2] Seyahi E.Takayasu arteritis: an update..Curr Opin Rheumatol2017;29:51-6

[3] Mohammad AJ.Takayasu arteritis in southern Sweden..J Rheumatol2015;42:853-8

[4] Gudbrandsson B,Garen T.Prevalence, incidence, and disease characteristics of Takayasu arteritis by ethnic background: data from a large, population-based cohort resident in Southern Norway..Arthritis Care Res (Hoboken)2017;69:278-85

[5] Watanabe Y,Tanemoto K.Current clinical features of new patients with Takayasu arteritis observed from cross-country research in Japan: age and sex specificity..Circulation2015;132:1701-9

[6] Isobe M,Arimura Y,Ito S.JCS 2017 Guideline on Management of Vasculitis Syndrome - Digest Version..Circ J2020;84:299-359

[7] Renauer P.The genetics of Takayasu arteritis..Presse Med2017;46:e179-87 PMCID:PMC5753771

[8] Facchinetti M,Gabriella Cardinale.A familial case of Takayasu arteritis: HLA-related genetic susceptibility and efficacy of anti-TNFα treatment in two Italian siblings..Int J Clin Rheumatol2018;13:341-5

[9] Chatterjee S,Tan CD.Clinical diagnosis and management of large vessel vasculitis: Takayasu arteritis..Curr Cardiol Rep2014;16:499

[10] Alibaz-Oner F,Direskeneli H.Advances in the diagnosis, assessment and outcome of Takayasu’s arteritis..Clin Rheumatol2013;32:541-6

[11] Devarasetti PK,Rajasekhar L.Pentraxin 3 is better than conventional inflammatory markers for disease activity assessment in Takayasu arteritis..Indian J Rheumatol2019;14:21-7

[12] Devarasetti PK,Irlapati RVP.SAT0364 pentraxin 3 as biomarker in assessment of disease activity in Takayasu arteritis..Ann Rheum Dis2016;75:798

[13] Direskeneli H,Merkel PA.Assessment of disease activity and progression in Takayasu’s arteritis..Clin Exp Rheumatol2011;29:S86-91 PMCID:PMC3645853

[14] Nair AM,Hindhumati M,Visalakshi J.Serum amyloid A as a marker of disease activity and treatment response in Takayasu arteritis..Rheumatol Int2017;37:1643-9

[15] Goel R,Mohan H,Jayaseelan V.Soluble-HLA-E: a follow up biomarker in Takayasu arteritis, independent of HLA-E genotype..Int J Rheum Dis2018;21:532-40

[16] Maksimowicz-McKinnon K,Hoffman GS.Limitations of therapy and a guarded prognosis in an American cohort of Takayasu arteritis patients..Arthritis Rheum2007;56:1000-9

[17] Kerr GS,Giordano J,Fauci AS.Takayasu arteritis..Ann Intern Med1994;120:919-29

[18] Kim ESH.Takayasu arteritis: challenges in diagnosis and management..Heart2018;104:558-65

[19] Barra L,Malette J.Imaging modalities for the diagnosis and disease activity assessment of Takayasu’s arteritis: a systematic review and meta-analysis..Autoimmun Rev2018;17:175-87

[20] Miyata T,Koyama H,Tada Y.Long-term survival after surgical treatment of patients with Takayasu’s arteritis..Circulation2003;108:1474-80

[21] Isobe M.Takayasu arteritis revisited: current diagnosis and treatment..Int J Cardiol2013;168:3-10

[22] Ogino H,Minatoya K,Tanaka H.Overview of late outcome of medical and surgical treatment for Takayasu arteritis..Circulation2008;118:2738-47

[23] Fields CE,Cooper LT,Noel AA.Takayasu’s arteritis: operative results and influence of disease activity..J Vasc Surg2006;43:64-71

[24] Zhang Y,Meng X,Fan P.Cardiac valve involvement in Takayasu arteritis is common: a retrospective study of 1,069 patients over 25 years..Am J Med Sci2018;356:357-64

[25] Goel R,Carette S,Hoffman GS.Derivation of an angiographically based classification system in Takayasu’s arteritis: an observational study from India and North America..Rheumatology (Oxford)2020;59:1118-27

[26] Kihara M,Yakuwa H,Hayashi S.Isolated left coronary ostial stenosis as the sole arterial involvement in Takayasu’s disease..J Intern Med1992;232:353-5

[27] Lanjewar C,Vaideeswar P.Isolated bilateral coronary ostial stenosis - an uncommon presentation of aortoarteritis..Int J Cardiol2007;114:e126-8

[28] Lie JT.Pathology of isolated nonclassical and catastrophic manifestations of Takayasu arteritis..Int J Cardiol.1998;66 Suppl 1:S11-21

[29] Kang EJ,Choe YH,Lee KN.Takayasu arteritis: assessment of coronary arterial abnormalities with 128-section dual-source CT angiography of the coronary arteries and aorta..Radiology2014;270:74-8

[30] Cipriano PR,Perlroth MG,Wexler L.Coronary arterial narrowing in Takayasu’s aortitis..Am J Cardiol1977;39:744-50

[31] Amano J.Coronary artery involvement in Takayasu’s arteritis. Collective review and guideline for surgical treatment..J Thorac Cardiovasc Surg1991;102:554-60

[32] Águeda AF,Luqmani RA,Cid M.Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis..RMD Open2019;5:e001020 PMCID:PMC6803017

[33] Keser G,Aksu K.Management of Takayasu arteritis: a systematic review..Rheumatology2014;53:793-801

[34] Misra DP,Agarwal V.Recent advances in the management of Takayasu arteritis..Int J Rheum Dis.2019;22 Suppl 1:60-8

[35] Tombetti E,Sabbadini MG.Management options for Takayasu arteritis..Expert Opin Orphan Drugs2013;1:685-93

[36] Weaver FA,Campen DH,Foran J.Surgical procedures in the management of Takayasu’s arteritis..J Vasc Surg1990;12:429-39

[37] Son JW,Dang Q,Shin EK.Recurrent restenosis following stent and rotational atherectomy of coronary artery stenosis in Takayasu’s arteritis..Int J Cardiol1998;65:295-300

[38] Jung JH,Song GG,Kim JH.Endovascular versus open surgical intervention in patients with Takayasu’s arteritis: a meta-analysis..Eur J Vasc Endovasc Surg2018;55:888-99

[39] Ueno M.Antiplatelet therapy in the treatment of Takayasu arteritis..Circ J2010;74:1079-80

[40] Ueda H,Saito Y.Studies on arteritis, with special reference to pulseless disease and its diagnosis..Naika1965;15:239-56

[41] Yang Y,Yang K,Meng X.Outcomes of percutaneous coronary intervention and coronary artery bypass grafting in patients with Takayasu arteritis..Int J Cardiol2017;241:64-9

[42] Emaminia A.Complete occlusion of the left main coronary artery ostium in Takayasu arteritis..J Thorac Cardiovasc Surg2008;135:695-6

[43] Yuan SM.Coronary artery involvements in Takayasu arteritis: systematic review of reports..Gen Thorac Cardiovasc Surg2020;

[44] Endo M,Nishida H,Nakazawa M.Angiographic findings and surgical treatments of coronary artery involvement in Takayasu arteritis..J Thorac Cardiovasc Surg2003;125:570-7

[45] Lupi-Herrera E,Marcushamer J,Horwitz S.Takayasu’s arteritis. Clinical study of 107 cases..Am Heart J1977;93:94-103

[46] Seko Y,Kawasaki A,Maeda K.Perforin-secreting killer cell infiltration and expression of a 65-kD heat-shock protein in aortic tissue of patients with Takayasu’s arteritis..J Clin Invest1994;93:750-8 PMCID:PMC293919

[47] Takeda N,Seko Y,Nakasone H.Takayasu myocarditis mediated by cytotoxic T lymphocytes..Intern Med2005;44:256-60

[48] Noel N,Le Hoang P,Costedoat-Chalumeau N.Small vessel involvement in Takayasu’s arteritis..Autoimmun Rev2013;12:355-62

[49] Lee GY,Ko SM,Lee SH.Cardiovascular manifestations of Takayasu arteritis and their relationship to the disease activity: analysis of 204 Korean patients at a single center..Int J Cardiol2012;159:14-20

[50] Hotchi M.Pathological studies on Takayasu arteritis..Heart Vessels Suppl1992;7:11-7

[51] Sharma BK,Radotra BD.An autopsy study of Takayasu arteritis in India..Int J Cardiol1998;66:S85-90

[52] Toledano K,Lorber A,Yigla M.Pulmonary arteries involvement in Takayasu’s arteritis: two cases and literature review..Semin Arthritis Rheum2011;41:461-70

[53] Yang J,Shi J,Yu X.Pulmonary artery involvement in Takayasu’s arteritis: diagnosis before pulmonary hypertension..BMC Pulm Med2019;19:225 PMCID:PMC6881988

[54] Jervell A.Pulseless disease..Am Heart J1954;47:780-4

[55] Soto ME,Ramirez-Quito O.Echocardiographic follow-up of patients with Takayasu’s arteritis: five-year survival..Echocardiography2006;23:353-60

[56] Yoshida M,Ishii T,Akita K.Retrospective analysis of 95 patients with large vessel vasculitis: a single center experience..Int J Rheum Dis2016;19:87-94

[57] Luo F,Li JJ.Inflammatory response is associated with aortic dissection..Ageing Res Rev2009;8:31-5

[58] Shirai T,Harrison DG,Weyand CM.Macrophages in vascular inflammation--from atherosclerosis to vasculitis..Autoimmunity2015;48:139-51 PMCID:PMC4606880

[59] Wang Y,Dong L,Wang X.Circulating matrix metalloproteinase patterns in association with aortic dilatation in bicuspid aortic valve patients with isolated severe aortic stenosis..Heart Vessels2016;31:189-97

[60] Kaku Y,Tomioka H.Surgery for aortic regurgitation and aortic root dilatation in Takayasu arteritis..Asian Cardiovasc Thorac Ann2015;23:901-6

[61] Miyata T,Deguchi J,Namba T.Anastomotic aneurysms after surgical treatment of Takayasu’s arteritis: a 40-year experience..J Vasc Surg1998;27:438-45

[62] Bougioukas I,Popov AF.Re-do aortic operation in a young patient for aggressive Takayasu’s arteritis..J Cardiothorac Surg2012;7:9 PMCID:PMC3508840

[63] Matsuura K,Kobayashi J,Matsuda H.Surgical treatment of aortic regurgitation due to Takayasu arteritis: long-term morbidity and mortality..Circulation2005;112:3707-12

[64] Adachi O,Akasaka J,Iguchi A.Surgical management of aortic regurgitation associated with Takayasu arteritis and other forms of aortitis..Ann Thorac Surg2007;84:1950-4