IgG4-Related Cardiovascular Disorders

Tajima, Miyu; Nagai, Ryozo; Hiroi, Yukio

doi:10.1536/ihj.13-321

Cited by 87 publications

(77 citation statements)

References 113 publications

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“…50) The therapeutic corticosteroid dosage required to treat IgG4-related diseases differs case-by-case, and Tajima and colleagues have suggested that treatment of IgG4-related cardiovascular diseases might require higher doses of corticosteroids than other IgG4-related diseases. 51) IgG4-related diseases can involve any organs. Therefore, it is important to survey for extra-cardiovascular lesions when IgG4-related cardiovascular disease is suspected.…”

Section: Discussionmentioning

confidence: 99%

Immunoglobulin G4-Related Cardiovascular Diseases

Misawa

2017

ATCS

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Section: Discussionmentioning

confidence: 99%

Immunoglobulin G4-Related Cardiovascular Diseases

Misawa

2017

ATCS

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“…Currently, IgG4RD is recognized as one of the causes of vasculitis, and aneurysmal formation is thought to be the principle feature of IgG4-related vascular disease (9). In our case, not only aneurysmal formation but also stenotic lesions were observed, and these were thought to be uncommon.…”

Section: Discussionmentioning

confidence: 48%

Multiple Coronary Artery Aneurysms and Thoracic Aortitis Associated with IgG4-related Disease

et al. 2016

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A 60-year-old man was admitted due to the onset of right coronary artery (RCA) aneurysms. Coronary angiography showed two RCA aneurysms and focal stenosis with limitations in the blood flow. Balloon angioplasty was performed. However, the follow-up coronary angiography showed restenosis, an enlarged proximal aneurysm and a newly formed aneurysm. The serum immunoglobulin G4 level was elevated to 1,350 mg/dL and fluorodeoxyglucose positron emission tomography showed increased uptake in the ascending aorta, so the patient was diagnosed with immunoglobulin G4-related vascular disease. The prevention of further enlargement of the aneurysms and an improvement in the RCA flow were achieved with steroid therapy. Steroid therapy may therefore be effective for immunoglobulin G4-related vascular disease.

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“…18 F-fluorodeoxyglucose positron emission tomography/ CT (FDG PET/CT) has successfully been used to identify coronary artery involvement of IgG4-RD and to follow up disease activity in IgG4-RD and Takayasu vasculitis. [15][16][17][18][19][20] FDG PET/CT could therefore be considered to gauge the extent of the patient's active inflammation before and after therapy. Additionally, serological IgG4, ESR, and CRP levels have been shown to respond to treatment with corticosteroids and rituximab and seem to correlate with clinical improvement.…”

Section: Patient Presentation (Continued)mentioning

confidence: 99%

Bulging at the Root: An Inflammatory Tale

et al. 2016

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1969 ForewordInformation about a real patient is presented in stages (boldface type) to an expert clinician (Dr Bhatt), who responds to the information, sharing his reasoning with the reader (regular type). A discussion by the authors follows. P atient presentation: A 54-year-old man was transferred from an outside institution after he presented to the emergency department following the sudden onset of nonradiating, substernal chest pressure, dyspnea, diaphoresis, and nausea while brushing his teeth. Before transfer, the patient received a full dose of aspirin and was started on unfractionated heparin with biomarker and electrocardiographic evidence of a non-ST-segment-elevation myocardial infarction.His medical history included hypertension, dyslipidemia, long-standing severe atopic dermatitis, and remote large-cell non-Hodgkin lymphoma that had remained in remission for the past 9 years after treatment with rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisolone. Over the preceding year, the patient had suffered recurrent admissions for acutely decompensated heart failure with a newly appre- Dr Bhatt: Several features of the patient's recent history are concerning. The cause of the patient's severe LV systolic dysfunction remains undefined. Evidence from large epidemiological studies suggests that in some populations, >60% of unexplained cardiomyopathies may be attributable to coronary heart disease.1 This patient's family history of early coronary artery disease, personal history of classic coronary artery disease risk factors, and regional findings on his myocardial perfusion study support this possibility. In terms of alternative potential causes for his cardiomyopathy, the patient's exposure to doxorubicin places him at up to a 5-fold risk of developing impaired myocardial function, depending on the total cumulative dose of anthracyclines that he received, concomitant radiation exposure, and exposure to additional cardiotoxic medications.2 Additionally, the patient's diffuse aneurysmal disease and rapidly progressive renal disease raise the concern for a possible underlying connective tissue disease, vasculitis, or infectious process. Lastly, renovascular disease is an important and often underrecognized source of recurrent pulmonary edema. This is especially true in the context of a rising serum creatinine level and history of hypertension.In the setting of this patient's non-ST-segment-elevation myocardial infarction with high-risk characteristics, including severe LV dysfunction and recurrent episodes of angina despite medical therapy over the past year, coronary arteriography would be the appropriate next step. Indeed, some experts feel that most patients with unexplained significant LV dysfunction should undergo coronary angiography regardless of stress test findings. Given the extent of the patient's aneurysmal disease and concern for a possible underlying systemic process, a complete CT vascular survey to exclude additional territories of disease would also be reasonab...

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IgG4-Related Cardiovascular Disorders

Cited by 87 publications

References 113 publications

Immunoglobulin G4-Related Cardiovascular Diseases

Immunoglobulin G4-Related Cardiovascular Diseases

Multiple Coronary Artery Aneurysms and Thoracic Aortitis Associated with IgG4-related Disease

Bulging at the Root: An Inflammatory Tale

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