P202 A study on myocardial dysfunction in Indian patients with Takayasu's arteritis

Abstract

Abstract Background/Aims Takayasu’s arteritis (TA) is a form of predominantly large vessel vasculitis affecting young individuals. Signs of vascular insufficiency or systemic inflammation may be seen in the vast majority of patients, with cardiac involvement noted in more than one-third of the cases. Previous histopathologic studies from India have revealed the presence of myocarditis in up to 50% of patients. We conducted this study to assess myocardial dysfunction using Speckle Tracking Echocardiography (STE), a novel method to assess global longitudinal systolic strain (GLSS), in TA patients and healthy controls. Methods This was a cross-sectional, case-control study. Between August 2018 and May 2021, all consenting adult patients classified as per the ACR 1990 Criteria as Takayasu’s arteritis were included in the study after taking their informed consent. Age and gender-matched healthy controls without known comorbidities like hypertension, diabetes, or coronary artery disease were included for comparison. Demographic, clinical, and laboratory parameters were assessed. All enrolled participants underwent 2D echocardiography with speckle tracking and GLSS evaluation as well as B-mode ultrasonography to measure carotid intimal medial thickness (CIMT) of bilateral carotid arteries, by a single, blinded cardiologist with over 20 years of experience in his field. The study was approved by the Institutional Ethics Committee. Results Fifty patients with TA who consented to the study were included, with fifty healthy controls. 66% of the cohort were female. TA patients had significantly lower mean LVEF (56% vs 60%, p < 0.0001), worse mean GLSS (-19.3% vs -20.9%, p = 0.003), more patients with GLSS >-19.7 (48% vs 24%, p = 0.01), and higher mean CIMT values (0.58mm vs 0.44mm, p = 0.001) than the healthy controls. Cases with GLSS less negative than -19.7% (24 out of 50) were significantly older (mean age 42.8 vs 35.4 years, p = 0.049), had more cardiac (62.5% vs 19.2%, p = 0.02) and coronary artery involvement (37.5% vs 7.7%, p = 0.011). Mean CIMT values were significantly more in patients with active disease as per the ITAS 2010 score. GLSS could not differentiate between active and inactive disease, nor did they correlate with raised inflammatory markers. There was no significant correlation between higher CIMT values and worse GLSS. Conclusion This is a pilot study comparing TA cases with healthy controls using STE and CIMT values. While mean CIMT values and GLSS were increased in patients with TA, GLSS did not correlate with disease activity status. Older age and a greater proportion of patients with cardiac involvement were the only significant differences noted in patients with worse GLSS. Longitudinal studies based on STE may help us document changes in subclinical myocarditis in TA. Disclosure R. Bajaj: None. S. Ghosh: None. D. Tanna: None. D. Yadavalli: None. W. Kazi: None. V. Singal: None. R. Gupta: None.