Involvement of the pulmonary arteries in patients with Takayasu arteritis: a prospective study from a single centre in China

Abstract

Background: Takayasu arteritis (TA) is a large vessel vasculitis that can involve pulmonary arteries (PAs). We studied multiple clinical characteristics related to pulmonary artery involvement (PAI) in TA patients. Methods: We enrolled 216 patients with TA from a large prospective cohort. PAI was assessed in each patient based on data from magnetic resonance angiography/computed tomography angiography. Pulmonary hypertension, cardiac function, and pulmonary parenchymal lesions were evaluated further in patients with PAI based on echocardiography, the New York Heart Association Functional Classification, and pulmonary computed tomography, respectively. These abnormalities related to PAI were followed up to evaluate treatment effects. Results: PAI was detected in 56/216 (25.93%) patients, which involved the pulmonary trunk, main PAs, and small vessels in the lungs. Among patients with PAI, 28 (50%) patients were accompanied by pulmonary hypertension, which was graded as 'severe' in 9 (16.07%), 'moderate' in 10 (17.86%), and mild in 9 (16.07%). Twenty-six (46.43%) patients showed advanced NYHA function (III, 20, 35.71%; IV, 6, 10.71%). Furthermore, 21 (37.50%) patients presented with abnormal pulmonary parenchymal lesions in the area corresponding to PAI (e.g. the mosaic sign, infarction, bronchiectasis). During follow-up, two patients died due to heart failure and pulmonary thrombosis. In the remaining patients, the abnormalities mentioned above improved partially after routine treatment. Conclusions: PAI is common in TA patients. PAI can cause pulmonary hypertension, cardiac insufficiency, and pulmonary parenchymal lesions, which worsen patients' prognosis.

The clinical features of pulmonary artery involvement in Takayasu arteritis and its relationship with ischemic heart diseases and infection

“…The effect of PAI has not been fully elucidated. PAI is reported with TAK in 5.7 to 25.93 % (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). In this study, the presence of PAI was 14.6 %, consistent with previous studies.…”

“…Vessel wall in ammation leads to arterial wall thickening, dilation, stenosis and occlusion. PA involvement (PAI) occurs in 5.7-25.93 % of all cases (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). TAK with PAI is occasionally complicated with pulmonary hypertension (PH), resulting in the risk of early mortality (8, 11).…”

Organizing Pneumonia as the First Presentation in a Patient with Takayasu Arteritis: A Report of Rare Complication

“…These findings suggest that inflammation may spread to the peripheral pulmonary artery wall, resulting in micropulmonary infarction, alveolar hemorrhaging, and fibrin deposited during the healing process, leading to organizing pneumonia. In some cases of Takayasu arteritis, biopsy results of the pneumonia-like lesions indicated hemorrhagic infarction accompanied by fibrinoid necrosis of the small vessels and infiltration of inflammatory cells ( 3 ). In the current case, we found inflammatory wall thickening and stenosis in the proximal part of the left lower lobe pulmonary artery but no evidence of vasculitis in the peripheral part.…”

“…Respiratory symptoms appear in approximately 10.8% of patients with Takayasu arteritis ( 1 ). Recently, it has been reported that 6.3% to 25.9% of patients have pulmonary artery involvement ( 2 , 3 ). In Takayasu arteritis, pulmonary artery involvement sometimes causes respiratory symptoms without visible pulmonary artery stenosis, pulmonary artery infarction, or pulmonary hypertension.…”

Correlation Between Vascular Inflammation Markers, Diastolic Dysfunction and Cardiovascular Risk in Patients with Takayasu Arteritis

“…Few data are available on ultrasound-based assessment of cardiac function in large vessel vasculitis, although features of early cardiac involvement have been described in other autoimmune diseases [13,14]. Nevertheless, an increase in left ventricular mass [15] and indirect involvement of the right ventricle, secondary to pulmonary hypertension, have been detected by echocardiography in TAK patients [16]. Thus, as with several other diseases associated with inflammatory features in the arterial wall, such as hypertension and atherosclerosis [17,18] and oxidative stress [18,19], changes in cardiac structure and function may characterize the progression of TAK disease, increasing the overall risk of cardiovascular morbidity/mortality [20,21].…”