s36_ab7

Predictors of left ventricular dysfunction in patients with Takayasu's or giant cell aortitis

.H. Pfizenmaier, F.O. Al Atawi, Y. Castillo, K. Chandrasekaran, L.T. Cooper

Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA

ABSTRACT
Objectives
The aim of this study was to determine the clinical and angiographic predictors of left ventricular systolic dysfunction (LVSD) from a relatively large and angiographically characterized Takayasu's or Giant Cell aortitis (TA/GCA) population.

Background
LVSD in patients with TA/GCA has been described in case re-ports and attributed variously to hemodynamic and immunologic factors. The predictors of LVSD in patients with an-giographically confirmed TA/GCA are not known.

Methods
We identified 78 patients, with angiographically confirmed TA/GCA that underwent transthoracic echocardiography (TTE) at Mayo Clinic. Echocardiograms were then reviewed independently by reviewers blinded to clinical and angiographic data. LVSD was defined as an ejection fraction (LVEF) less than 50%.

Results
The study population was 84% Caucasian (54/78), 91% female (58/78), and had a mean age of disease onset of 30 years (±15 years). LVSD was present in 14 of 78 patients (18%) with TA/GCA. The mean LVEF in the LVSD group (n = 14) was 37% ±7%, compared to an LVEF of 62% ±6% (p<0.0001) in those without LVSD (n = 64). LVSD was not associated with hypertension or aortic regurgitation (p >0.5). However, LVSD was found in 43% (9/21) of patients with aortic arch in-volvement, versus only 9% (5/57) of patients without aortic arch involvement (p =0.0013). Patients with LVSD had a median of 2 (range 1-4) involved aortic segments compared to a median of 1 (range 1-4) among those without LVSD (p=0.013).

Conclusions
In TA/GCA aortitis, LVSD is associated with involvement of the aortic arch and with the greater extent of aortic involvement. The hemodynamic variables, aortic regurgitation and systemic hypertension, were not associated with LVSD, consistent with reports that cardiac inflammation is responsible for LVSD in a majority of cases. Ours is the first study to estimate an incidence of LVSD in patients with TA/GCA aortitis, which was 18%.

Key words
Dilated cardiomyopathy, aortitis, myocarditis, Takayasu's arteritis, giant cell arteritis.

The authors have no conflicts of interest or financial relationships to disclose.
Please address correspondence to: Leslie T. Cooper, M.D., Consultant, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
E-mail: cooper.leslie@mayo.edu