Cardiovascular Manifestations of Systemic Vasculitides
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VASCULITIS (L ESPINOZA, SECTION EDITOR)
Cardiovascular Manifestations of Systemic Vasculitides Luis H. Silveira 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Vasculitis can cause heart disease and are associated with premature atherosclerosis, causing increased morbidity and mortality. Consequently, it is important to know how they can affect the cardiovascular system in order to detect and treat the abnormalities in earlier phases. Recent Findings A clear increasing trend of inpatient burden of myocardial infarction and thromboembolic events in granulomatosis with polyangiitis has been observed lately. Behçet’s disease has been linked to an increased risk of atrial fibrillation. Studies showing increased atherosclerosis and thromboembolic phenomena in vasculitis are continuously published. Improvement in imaging techniques has consistently showed that subclinical cardiovascular involvement is frequent. Summary Vasculitis may affect seriously the cardiovascular system causing an important increase in morbidity and mortality. Subclinical involvement is frequent. Early treatment with immunosuppression and sometimes surgery, is of paramount importance to improve the prognosis. Keywords Vasculitis . Heart disease . Cardiovasculardisease . Takayasuarteritis . Eosinophilicgranulomatosiswithpolyangiitis . Behcet’s disease
Introduction Systemic vasculitides are rarely associated with cardiac disease; less than 10% of patients are affected overall [1]. However, most of the vasculitic entities can cause heart disease and the frequency of affection varies among them. Takayasu arteritis (TA) and eosinophilic granulomatosis with polyangiitis (EGPA) are the most frequently affected by heart disease. The early detection of these abnormalities is of paramount importance since they are associated with increased morbidity and mortality and treatment should be started as soon as they are detected. Vasculitides are related to cardiovascular risk by means of the severe inflammatory process in the vessel wall [2]. Moreover, they are also associated with premature atherosclerosis [3]. Topical Collection on Vasculitis * Luis H. Silveira [email protected] 1
Department of Rheumatology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No. 1, colonia Sección XVI, 14080 Ciudad de México, Mexico
I will review the cardiovascular manifestations observed in the different adult primary vasculitides according to the vessel size involved.
Large-Vessel Vasculitis Takayasu Arteritis Cardiac abnormalities are very frequent in TA, around 40% of patients have them. They are associated with increased morbidity and mortality and are related to poor prognosis [4••]. Cardiovascular manifestations have also been linked to disease activity [5]. The most frequent structures involved are the valves, the coronary arteries, the myocardium, and the pericardium (Table 1). Valvular abnormalities are the most common cardiac manifestations in TA. Aortic insufficiency (AI) has been present in 15 t
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