Clinical characteristics and risk factors of coronary artery lesions in chinese pediatric Takayasu arteritis patients: a retrospective study

Abstract

Backgroud To summarize the clinical characteristics and identify the risk factors for pediatric Takayasu arteritis (TAK) with coronary artery lesions (CALs). Methods Clinical data of pediatric TAK patients in our center were retrospectively assessed. Independent risk factors for CALs were identified using multivariate logistic regression analysis. Survival analysis was used to compare differences in survival rates between the groups. Results Among the 66 pediatric TAK cases, the incidence of accompanying CALs was 39.4%. In the CAL group, 19 (73.1%) cases started within 36 months. None of the patients had symptoms of angina or ischemia on electrocardiogram (ECG), the CALs were detected using coronary ultrasound. The CALs most commonly were the left main and right coronary arteries. The lesions were mostly small or middle coronary artery aneurysms; some children may have giant coronary aneurysmal dilations, thrombosis and heart failure. The age of onset and symptom onset to diagnosis in TAK patients with CAL were lower than those in TAK patients without CAL(P < 0.005). TAK patients with CAL had significantly higher CRP,WBC, PLT,TNF-α and IL-2R levels (P < 0.05), lower HGB (P = 0.01), lower rate of renal artery stenosis (RAS) (P = 0.009). In multivariate logistic regression, the risk factors for pediatric TAK combined with CAL included the age of TAK onset (OR = 0.9835, 95% CI: 0.9710–0.9946, P = 0.006) and RAS (OR = 0.1901, 95% CI: 0.0386–0.7503, P = 0.03). In addition, there was no significant difference in survival rates between the two groups after regular treatment. Conclusion This study showed that the occurrence of CAL in pediatric TAK patients has a relatively more rapid clinical course, and a stronger inflammatory state at the time of diagnosis. The earlier the age of TAK onset and without RAS are more likely to cause CAL.

Coronary artery lesions in Takayasu arteritis

“…Hence, imaging studies play a crucial role in diagnosing and monitoring the disease [ 56 ]. Studies have shown that children with TAK with CAL have higher levels of leukocytes, platelets, C-reactive protein, tumor necrosis factor-α (TNF-α), and interleukin-2 receptor (IL-2R) compared to those without lesions [ 31 ].…”

“…According to the study by Xu et al [ 31 ], all 26 pediatric TAK patients were treated with GCs precombined with infliximab and MTX, TCZ and MTX, and cyclophosphamide (CP) in 17 (65.4%), 2 (7.7%), and 5 (19.2%) cases, respectively.…”

“…It was also noted that MACE was nearly 44% higher in men with TAK and CAL than in women [ 32 ]. However, Xu et al [ 31 ] found that after treatment, there was no significant difference in the survival rate in children with CAL compared to those without CAL ( p > 0.05).…”

“…Coronary artery lesions are a distinct but not uncommon type of artery involvement in TAK, observed in 5.9–58.2% of patients according to visualization methods ( Table I ) [ 3 , 31 – 32 ].…”

“…It has been established that CAL in children and adults has differences, with coronary artery stenosis being the most common in adults, while children exhibited dilation of the coronary arteries. Xu et al [ 31 ] observed CAL in 39.4% of children with TAK diagnosed using ultrasound, and none of them had AP or signs of ischemia on the ECG.…”