Session Title: Vasculitis
Session Type: Abstract Submissions (ACR)
Background/Purpose: Cardiac involvement in Takayasu’s arteritis (TA) is a leading cause of death. Previous studies reported a high incidence of myocardial involvement using exercise thallium-201 scintigraphy whereas macrovascular coronary lesions are not frequent in coronary angiography.
Objective: The aim of the present study is to evaluate coronary microvascular dysfunction in TA using dipyridamole thallium-201 myocardial scintigraphy.
Methods: Twenty five consecutive patients with TA [median (IQR) age 48 (36–60) years, with 18 (72%) females, and median duration of disease between diagnosis and enrollment 7 (3–11) years] were prospectively examined by 201Tl myocardial scintigraphy at rest and after dipyridamole induced stress.
Results: Among 25 TA patients, 21 (84%) had abnormal scintigraphic findings and 4 (16%) had normal myocardial perfusion. Using 17-segments model for quantitative image analysis, dipyridamole significantly improved resting 201Tl myocardial perfusion in 14/23 patients (60.9% with reversible defects in at least 3 segments) versus 9/23 (39.1% with permanent defects or reversible defects in less than 3 segments). We were able to examine coronary artery stenoses in 11 patients including 10 patients with thallium perfusion abnormalities. Among patients with thallium perfusion abnormalities, significant coronary artery stenoses were present in only 2/11 (18.2%) patients. No significant difference was found between TA patients with normal and abnormal myocardial perfusion scintigraphy in terms of cardiovascular risk factors or characteristics of TA.
Conclusion: Our results demonstrate a high incidence of myocardial involvement in TA patients mainly related to microcirculation impairment. This clearly demonstrate that this large vessel vasculitis, also affect vessels of small size. Systematic cardiac evaluation including dipyridamole thallium-201 stress myocardial scintigraphy is required to properly identify TA patients with asymptomatic myocardial involvement. Further studies are needed to determine whether myocardial findings using dipyridamole thallium-201 stress myocardial scintigraphy have an impact on the prognosis and treatment strategy.
J. Y. Devaux,
M. Resche Rigon,
P. Cacoub Sr.,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/asymptomatic-myocardial-ischemic-disease-in-takayasus-arteritis/