CARDIAC MANIFESTATION IN PATIENTS WITH TAKAYASU'S ARTERITIS IN THE CONTEXT OF ALTERATION OF VENTRICULAR-ARTERIAL COUPLING

Abstract

Objective: Takayasu's arteritis is a chronic, progressive inflammatory disease of the large vessels, diffusely disseminated. Thus, it can affect any organ system and can have a wide range of clinical manifestations. In the absence of control of triggering factors and in the absence of treatment, the long-lasting evolution of the inflammation and the detection in advanced stages has led to the appearance of vascular stiffness and left ventricular hypertrophy. Therefore, the decrease in both arterial and ventricular elastance has led to a decrease in mechanical work and myocardial efficiency, which is the expression of altered ventricular-arterial coupling. Design and method: We present the case of a 25-year-old patient, with no significant personal history, admitted to our clinic for the management of high blood pressure values. Biologically, the patient has stage IV chronic kidney disease and significant inflammatory syndrome. The echocardiography shows significant concentric ventricular hypertrophy, with mild systolic dysfunction, due to diffuse hypokinesia and low ventricular mechanical work. Given the multiple arguments of renovascular pathology, we took a native CT angiography which showed circumscribed lesions in the vertebral arteries, carotid, upper mesenteric and left subclavian artery. Therefore, we suspect the Takayasu's arteritis as a possible diagnosis and the treatment with systemic corticosteroid was started, which led to the decrease of the inflammatory syndrome and to the reduction of the inflammation at carotid arteries level, evidenced by a vascular Doppler ultrasound. Results: Ventricular-arterial coupling is important for understanding the pathophysiological mechanisms underlying both arterial and left ventricular remodeling. The development of advanced imaging techniques has led to the possibility of non-invasive analysis of the ventricular-atrial relationship which is important for determining the mechanical work, and thus for a better understanding of the mechanisms that led to the development of ventricular hypertrophy. Conclusions: Although left ventricular hypertrophy is common in patients with high blood pressure, in a young patient thorough investigation of other possible etiologies has an important role in therapeutic management. Contrary to the literature data, in the present case there is an association between the episodes of severe hypertension and the ones of arteritis activity.