Coronary artery vasculitis: a review of current literature

Kartheek Garikapati,Shaun Khanna,Mohan V Bhojaraja,Daniel S L Goh,Kenneth Cho,Phillip Lo,Surjit Tarafdar

doi:10.1186/s12872-020-01813-6

Abstract

Cardiac vasculitis is recognized as a heterogeneous disease process with a wide spectrum of manifestations including pericarditis, myocarditis, valvular heart disease and less frequently, coronary artery vasculitis (CAV). CAV encompasses an emerging field of diseases which differ from conventional atherosclerotic disease and have a proclivity for the younger population groups. CAV portends multiple complications including the development of coronary artery aneurysms, coronary stenotic lesions, and thrombosis, all which may result in acute coronary syndromes. There are several aetiologies for CAV; with Kawasaki’s disease, Takayasu's arteritis, Polyarteritis Nodosa, and Giant-Cell Arteritis more frequently described clinically, and in literature. There is a growing role for multi-modality imaging in assisting the diagnostic process; including transthoracic echocardiography, cardiac magnetic resonance imaging, computed tomography coronary angiography, fluorodeoxyglucose-positron emission tomography and conventional coronary angiogram with intravascular ultrasound. Whilst the treatment paradigms fundamentally vary between different aetiologies, there are overlaps with pharmacological regimes in immunosuppressive agents and anti-platelet therapies. Interventional and surgical management are is a consideration in select populations groups, within a multi-disciplinary context. Further large-scale studies are required to better appropriately outline management protocols in this niche population.

Highlights

Vasculitis is a general term that encompasses a group of disorders characterised by inflammation of blood vessels [1]
Whilst cardiac manifestations of systemic vasculitis are rarely seen in practice, their presence often serve as a poor prognostic factor [2]
Cardiac manifestations that are frequently described in literature include pericarditis, myocarditis, valvular heart disease and less commonly, coronary artery vasculitis (CAV) [3]

Summary

Introduction

Vasculitis is a general term that encompasses a group of disorders characterised by inflammation of blood vessels [1]. Cardiac manifestations that are frequently described in literature include pericarditis, myocarditis, valvular heart disease and less commonly, coronary artery vasculitis (CAV) [3]. This is of key importance as a large proportion of cardiac manifestations of vasculitis can be clinically silent during the early stages of the disease process, along with logistical difficulty in conducting a coronary artery biopsy for histo-pathological assessment [24].

Results

Conclusion