Prognostic Value of Brachial–Ankle Pulse Wave Velocity in Patients With Takayasu Arteritis With Drug‐Eluting Stent Implantation

Abstract

Objective. This study investigates the long-term outcomes of drug-eluting stent (DES) implantation in patients with Takayasu arteritis (TAK). Methods. Data on 48 TAK patients and 40 age-, sex-, and severity-matched patients with coronary artery disease (CAD) receiving DES implantation and hospitalized in Fuwai Hospital from February 2004 to March 2014 were assessed. The clinical features, laboratory data, coronary angiographic findings, treatment, and followup outcomes were summarized retrospectively. Major adverse cardiac events (MACE), which include all-cause death, nonfatal myocardial infarction, and nonfatal target vessel revascularization, were recorded. Results. TAK patients exhibited increased mean 6 SD brachial-ankle pulse wave velocity (baPWV) compared with patients with CAD (17.0 6 3.8 versus 13.8 6 3.0 meters/second; P 5 0.002). However, CAD patients had higher levels of lowdensity lipoprotein cholesterol (2.5 6 1.0 versus 2.3 6 0.8 mmoles/liter; P 5 0.04). Multiple linear regression analysis revealed that baPWV was independently associated with the extent of CAD, assessed by the SYNTAX (Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery) score (b 5 0.33, P 5 0.03), in TAK patients. DES implantation was deployed in 73 coronary lesions in 48 TAK patients, and restenosis occurred in 48 lesions after an average of 25.6 months (range 9.0-68.0 months) following intervention. Logistic regression analysis identified that a baPWV of 17.00 meters/second or higher (odds ratio 5.50, 95% confidence interval [95% CI] 2.1-16.6, P 5 0.008) may be considered as an independent predictor of DES restenosis. Moreover, the multivariate Cox proportional hazards model demonstrated that a baPWV of 17.00 meters/second or higher (hazard ratio 3.36, 95% CI 1.51-7.52, P 5 0.003) was significant and may serve as an independent predictor of MACE in TAK patients who underwent DES implantation. Conclusion. DES in-stent restenosis remains a challenge, affecting the long-term outcomes of patients with TAK. Measuring increased arterial stiffness through baPWV, with the addition of inflammation status monitoring during followup, would be of great clinical value to identify TAK patients with DES who have a high risk for in-stent restenosis and MACE.

Prognostic impacts of glucocorticoid treatment in patients with polymyalgia rheumatica and giant cell arteritis

“…Previous research on arterial stiffness in PMR and/or large vessel vasculitis, GCA and Takayasu's arteritis, is limited to a few studies [37][38][39][40][41][42] . In a study by Pieringer et al in 13 patients with newly diagnosed PMR and 30 agesex-matched subjects as a control group, AIx tended to be higher in the PMR group and improved significantly from 28.5 to 25.3 (p = 0.006) after 4 weeks of treatment with 25 mg/day prednisolone 37 .…”

Brachial-Ankle Pulse Wave Velocity is Increased and Associated with Disease Activity in Patients with Takayasu Arteritis

“…The iliac region must be exposed before the femoral sensor is located on the femoral artery, in the measurement of cf-PWV. Finally, we already proved the prognostic value of ba-PWV in the patients with Takayasu Arteritis with drug-eluting stent implantation 19) . Therefore, we think ba-PWV is a more appropriate non-invasive quantification of arterial stiffness for the patients with TAK comparing with cf-PWV.…”

Pulse wave velocity, carotid intima media thickness and flow-mediated dilation in Takayasu arteritis: a systematic review

“…Two articles were requoted from the reference lists of eligibly identified studies. A total of 15 studies were available for the present review [13,[25][26][27][28][29][30][31][32][33][34][35][36][37][38].…”

“…The baPWV and cfPWV levels were significantly higher in TA patients than in controls in all the studies [25][26][27][28][29][30]. One study on crPWV showed that the TA patients in patients were higher than those in controls [26], while another did not [25].…”

“…As shown in Table I, there were six studies that evaluated the PWV levels [25][26][27][28][29][30], two studies used both carotid-radial PWV (crPWV) and carotid-femoral PWV (cfPWV) [25,26], two studies used brachial-ankle PWV (baPWV) [27,28], and two studies used cfPWV [29,30]. The systolic blood pressure (BP) levels [25][26][27]30] and diastolic BP levels [26,27] were significantly higher in TA patients than in controls. In two other studies, the pulse pressure (PA) levels in TA patients were higher than those in controls, although the systolic and diastolic BP levels were similar in TA patients and controls [28,29].…”