Echocardiographic Assessment in Patients with Granulomatosis with Polyangiitis

Abstract

Granulomatosis with polyangiitis (GPA) is one of the most common forms of systemic vasculitis, which usually involves the upper and lower respiratory tract, but it may affect also multiple organs. The aim of the study was an echocardiographic evaluation of cardiac involvement in GPA patients during remission. Eighty eight patients with GPA were evaluated in the study. The control group consisted of 40 age and sex-matched patients without a previous history of cardiovascular disease. We found that there were no differences between GPA and control groups regarding left atrial enlargement and interventricular septal hypertrophy. In one GPA patient, all heart chambers were enlarged. Left ventricle systolic function was decreased (LVEF ≤ 50%) in eight patients with GPA, and left ventricle wall motion abnormalities were observed in 12 patients. Left ventricle relaxation dysfunction, mitral valve and tricuspid valve regurgitation were observed with the same frequency in both GPA and control groups. Aortic regurgitation was the single abnormality that occurred significantly more often in the GPA group than in controls (28% vs. 7.5%; p = 0.03). Pericardial effusion was observed in three GPA patients and in none from the control group. We conclude that the most common echocardiographic manifestation in GPA patients in remission was aortic valve regurgitation. However, cardiac involvement in such patients is rather rare and in the majority of cases clinically insignificant.

Pleuritis and Pericarditis in Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis

“…4,5 The current study showed a higher prevalence of pericarditis in EGPA than in the other vasculitis subtypes, whereas pleuritis was similar between groups. This is consistent with other studies in which pericarditis is reported in 3.4% to 17.7% of patients with GPA 14,15,20,21 and 6% to 22.5% of patients with MPA. 12,13,20 Pleuritis has been found in 5% to 20% of patients with GPA and MPA.…”

Atherosclerosis in antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis

“…Coronary artery vasculitis leading to myocardial infarction is rare and mostly restricted to case reports [30,31]. Gatenby et al [32] described a 28-year-old man who presented with a picture of classical GPA, and who, in the absence of fulminating renal or respiratory disease, died from myocardial infarction.…”

Granulomatosis With Polyangiitis (Wegener's Granulomatosis) Complicated by Pericarditis: Our Experience of Two Cases and Comparative Review of Literature

“…Mild subclinical pericardial effusions are found in the majority of patients, and large pericardial effusions and tamponade requiring pericardiocentesis with or without pericardial window is rare. 11,12 Pericardial effusions can develop in the absence of severe renal dysfunction, indicating that besides uremia, GPA vasculitis has a direct pathogenic role. 13 Absence of pathological evidence of granulomata or active vasculitis in pericardial tissue suggests that other inflammatory mechanisms associated with disease exacerbations are involved.…”