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Echocardiographic Assessment in Patients with Granulomatosis with Polyangiitis

  • Katarzyna ŻycińskaEmail author
  • Anna Borowiec
  • Tadeusz M. Zielonka
  • Tomasz Rusinowicz
  • Małgorzata Hadzik-Błaszczyk
  • Magda Cieplak
  • Kazimierz A. Wardyn
Chapter
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1022)

Abstract

Granulomatosis with polyangiitis (GPA) is one of the most common forms of systemic vasculitis, which usually involves the upper and lower respiratory tract, but it may affect also multiple organs. The aim of the study was an echocardiographic evaluation of cardiac involvement in GPA patients during remission. Eighty eight patients with GPA were evaluated in the study. The control group consisted of 40 age and sex-matched patients without a previous history of cardiovascular disease. We found that there were no differences between GPA and control groups regarding left atrial enlargement and interventricular septal hypertrophy. In one GPA patient, all heart chambers were enlarged. Left ventricle systolic function was decreased (LVEF ≤ 50%) in eight patients with GPA, and left ventricle wall motion abnormalities were observed in 12 patients. Left ventricle relaxation dysfunction, mitral valve and tricuspid valve regurgitation were observed with the same frequency in both GPA and control groups. Aortic regurgitation was the single abnormality that occurred significantly more often in the GPA group than in controls (28% vs. 7.5%; p = 0.03). Pericardial effusion was observed in three GPA patients and in none from the control group. We conclude that the most common echocardiographic manifestation in GPA patients in remission was aortic valve regurgitation. However, cardiac involvement in such patients is rather rare and in the majority of cases clinically insignificant.

Keywords

Aortic valve regurgitation Cardiac involvement Echocardiography Granulomatosis with polyangiitis Remission Vasculitis 

Notes

Acknowledgements

The authors thank Jennifer Bigaj for proofreading.

Conflict Interest

The authors declare no conflict of interest in relation to this article.

References

  1. Cocco G, Gasparyan AY (2010) Myocardial ischemia in Wegener’s granulomatosis: coronary atherosclerosis versus vasculitis. Open Cardiovasc Med J 4:57–62PubMedPubMedCentralGoogle Scholar
  2. Colin GC, Vancraeynest D, Hoton D, Jonard P, Gerber B (2015) Complete heart block caused by diffuse pseudotumoral cardiac involvement in granulomatosis with polyangiitis. Circulation 132:e207–e210CrossRefPubMedGoogle Scholar
  3. Davenport A, Goodfellow J, Goel S, Maciver AG, Walker P (1994) Aortic valve disease in patients with Wegener’s granulomatosis. Am J Kidney Dis 24:205–208CrossRefPubMedGoogle Scholar
  4. De la Prada FJ, Prados A, Ramos R, Munar MA, Losada P, Morey A (2003) Silent ischemic heart disease in patient with Wegener’s necrotizing glomerulonephritis. Nefrologia 23:545–549. Article in SpanishPubMedGoogle Scholar
  5. Dewan R, Trejo Bittar HE, Lacomis J, Ocak I (2015) Granulomatosis with polyangiitis presenting with coronary artery and pericardial involvement. Case Rep Radiol 2015:516437PubMedPubMedCentralGoogle Scholar
  6. Dupuy M, Marcheix B, Grunenwald E, Dickson Z, Cron C, Chauveau D (2009) Mitral regurgitation associated with Wegener’s granulomatosis. Ann Cardiol Angeiol (Paris) 58:180–182CrossRefGoogle Scholar
  7. Espitia O, Droy L, Pattier S, Naudin F, Mugniot A, Cavailles A, Hamidou M, Brunevald P, Agard C, Toquet C (2014) A case of aortic and mitral valve involvement in granulomatosis with polyangiitis. Cardiovasc Pathol 23:363–365CrossRefPubMedGoogle Scholar
  8. Faurschou M, Mellemkjaer L, Sorensen IJ, Svalgaard Thomsen B, Dreyer L, Baslund B (2009) Increased morbidity from ischemic heart disease in patients with Wegener’s granulomatosis. Arthritis Rheum 60:1187–1192CrossRefPubMedGoogle Scholar
  9. Florian A, Slavich M, Blockmans D, Dymarkowski S, Bogaert J (2011) Cardiac involvement in granulomatosis with polyangiitis (Wegener granulomatosis). Circulation 124:e342–e344CrossRefPubMedGoogle Scholar
  10. Flossmann O, Berden A, de Groot K, Hagen C, Harper L, Heijl C, Höglund P, Jayne D, Luqmai R, Mahr A, Mukhtyar C, Pusey C, Rasmussen N, Stegeman C, Walsh M, Westman K, for the European Vasculitis Study Group (2011) Long-term patient survival in ANCA-associated vasculitis. Ann Rheum Dis 70:488–494CrossRefPubMedGoogle Scholar
  11. Goodfield NE, Bhandari S, Plant WD, Morley-Davies A, Sutherland GR (1995) Cardiac involvement in Wegener’s granulomatosis. Br Heart J 73:110–115CrossRefPubMedPubMedCentralGoogle Scholar
  12. Grant SC, Levy RD, Venning MC, Ward C, Brooks NH (1994) Wegener’s granulomatosis and the heart. Br Heart J 71:82–86CrossRefPubMedPubMedCentralGoogle Scholar
  13. Guillevin L, Pagnoux C, Seror R, Mahr A, Mouthon L, Le Toumelin P (2011) The five-factor score revisited: assessment of prognoses of systemic necrotizing vasculitides based on the French Vasculitis Study Group (FVSG) cohort. Medicine (Baltimore) 90:19–27CrossRefGoogle Scholar
  14. Hazebroek MR, Kemna MJ, Schalla S, Sanders-van Wijk S, Gerretsen SC, Dennert R, Merken J, Kuznetsova T, Staessen JA (2015) Prevalence and prognostic relevance of cardiac involvement in ANCA-associated vasculitis: eosinophilic granulomatosis with polyangiitis and granulomatosis with polyangiitis. Int J Cardiol 199:170–179CrossRefPubMedGoogle Scholar
  15. Koyalakonda SP, Krishnan U, Hobbs WJ (2010) A rare instance of multiple valvular lesions in a patient with Wegener’s granulomatosis. Cardiology 117:28–30CrossRefPubMedGoogle Scholar
  16. Lacoste C, Mansencal N, Ben M’rad M, Goulon-Goeau C, Cohen P, Guillevin L, Hanslik T (2011) Valvular involvement in ANCA-associated systemic vasculitis: a case report and literature review. BMC Musculoskelet Disord 12:50CrossRefPubMedPubMedCentralGoogle Scholar
  17. Lawson TM, Williams BD (1996) Silent myocardial infarction in Wegener’s granulomatosis. Br J Rheumatol 35:188–191CrossRefPubMedGoogle Scholar
  18. Lionaki S, Hogan S, Jennette C, Hu YH, Hamra JB, Jennette JC, Falk RJ, Nachman PH (2009) The clinical course of ANCA small-vessel vasculitis on chronic dialysis. Kidney Int 76:644–651CrossRefPubMedPubMedCentralGoogle Scholar
  19. Mavrogeni S, Manoussakis MN, Karagiorga TC, Douskou M, Panagiotakos D, Bournia V, Cokkinos DV, Moutsopoulos HM (2009) Detection of coronary artery lesions and myocardial necrosis by magnetic resonance in systemic necrotizing vasculitides. Arthritis Rheum 61:1121–1129CrossRefPubMedGoogle Scholar
  20. McGeoch L, Carette S, Cuthberston D, Hoffman GS, Khalidi N, Koening CL, Langford CA, CA MA, Moreland L, Monach PA, Seo P, Specks U, Ytterberg SR, Merkel PA, Pagnoux C, Vasculitis Clinical Research Consortium (2015) Cardiac involvement in granulomatosis with polyangiitis. J Rheumatol 42:1209–1212CrossRefPubMedPubMedCentralGoogle Scholar
  21. Meryhew NL, Bache RJ, Messner RP (1988) Wegener’s granulomatosis with acute pericardial tamponade. Arthritis Rheum 31:300–302CrossRefPubMedGoogle Scholar
  22. Morbini PB, Dal Bello B, Arbustini E (1998) Coronary artery inflammation and thrombosis in Wegener’s granulomatosis-polyarteritis nodosa overlap syndrome. G Ital Cardiol 28:377–382PubMedGoogle Scholar
  23. Morelli S, Gurgo Di Castelmenardo AM, Conti F, Sgrecci A, Alessandri C, Bernardo ML, Valesini G (2000) Cardiac involvement in patients with Wegener’s granulomatosis. Rheumatol Int 19:209–212CrossRefPubMedGoogle Scholar
  24. Ntatsaki E, Carruthers D, Chakravarty K, D’Cruz D, Harper L, Jayne D, Luqmani R, Mills J, Mooney J, Venning M, Watts RA, BSR and BHPR Standards, Guidelines and Audit Working Group (2014) BSR and BHPR guideline for the management of adults with ANCA-associated vasculitis. Rheumatology (Oxford) 53:2306–2309CrossRefGoogle Scholar
  25. Oliveira GH, Seward JB, Tsang TS, Specks U (2005) Echocardiographic findings in patients with Wegener granulomatosis. Mayo Clin Proc 80:1435–1440CrossRefPubMedGoogle Scholar
  26. Papo T, Piette JC, Laraki R, Bletry O, Huong DL, Godeau P (1995) Silent myocardial infarction in Wegener’s granulomatosis. Ann Rheum Dis 54:233–234CrossRefPubMedPubMedCentralGoogle Scholar
  27. Parry SD, Clark DM, Campbell J (2000) Coronary arteritis in Wegener’s granulomatosis causing fatal myocardial infarction. Hosp Med 61:284–285CrossRefPubMedGoogle Scholar
  28. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, Authors/Task Force Members (2016) Guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37:2129–2200CrossRefPubMedGoogle Scholar
  29. Salazar-Exaire D, Ramos-Gordillo M, Vela-Ojeda J, Salazar-Cabrera CE, Sanchez-Uribe M, Calleja-Romero MC (2012) Silent ischemic heart disease in a patient with necrotizing glomerulonephritis due to Wegener’s granulomatosis. Cardiorenal Med 2:218–224CrossRefPubMedPubMedCentralGoogle Scholar
  30. Singh G, Bali SK, Koul V (2014) Aortic valve involvement in a patient with granulomatosis with polyangiitis. Arch Rheumatol 29:232–235CrossRefGoogle Scholar
  31. Yanda RJ, Guis MS, Rabkin JM (1989) Aortic valvulitis in a patient with Wegener’s granulomatosis. West J Med 151:555–556PubMedPubMedCentralGoogle Scholar
  32. Yildizer K, Paydas S, Serin E, Sagliker Y (1996) Wegener’s granulomatosis complicated by pericardial tamponade and renal failure. Nephron 72:339–340CrossRefPubMedGoogle Scholar
  33. Watts RA, Mooney J, Skinner J, Scott DG, MacGregor AJ (2012) The contrasting epidemiology of granulomatosis with polyangiitis (Wegener’s) and microscopic polyangiitis. Rheumatology (Oxford) 51:926–931CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Katarzyna Życińska
    • 1
    Email author
  • Anna Borowiec
    • 1
  • Tadeusz M. Zielonka
    • 1
  • Tomasz Rusinowicz
    • 1
  • Małgorzata Hadzik-Błaszczyk
    • 1
  • Magda Cieplak
    • 1
  • Kazimierz A. Wardyn
    • 1
  1. 1.Department of Family Medicine, Internal and Metabolic DiseasesWarsaw Medical UniversityWarsawPoland

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