Abstract
BackgroundThis study was performed to analyze the clinical manifestations, imaging features, and prognosis of Takayasu’s arteritis (TA) with pulmonary arteritis (PA).MethodsIn total, 51 of 815 patients with TA were diagnosed with PA at the Peking Union Medical College Hospital from 1986 to 2015. The patients’ medical records and radiographic data were retrospectively reviewed.ResultsThe patients comprised 39 women and 12 men with a median age of 33 years (range, 14–67 years). The most common symptoms were dyspnea (70.6%), cough (66.7%), hemoptysis (47.1%), and chest pain (45.1%). Computed tomography (CT) pulmonary angiography, pulmonary arteriography, and pulmonary perfusion imaging showed pulmonary artery stenosis or occlusion in 44 patients. A total of 82.4% of patients had lung parenchyma lesions on CT scans, indirectly indicating pulmonary artery involvement. Additionally, 58.8% of patients had pulmonary hypertension (PH) by echocardiography. Compared with the PH group, the non-PH group was characterized by a shorter disease duration; more symptoms such as fever, chest pain, and hemoptysis; an increased erythrocyte sedimentation rate; and a higher incidence of subpleural wedge-shaped shadows on chest CT (P < 0.05). The median follow-up period was 48 months (range, 1–212 months), and all three deaths occurred in the PH group.ConclusionsThe clinical manifestations of TA with PA are nonspecific. PH often complicates PA and is associated with a poor prognosis. Early clinical manifestations such as repeated fever, chest pain, hemoptysis, and recurrence of subpleural wedge-shaped shadows on chest CT should arouse suspicion of PA in patients with TA and prompt further investigations. This may allow PA to be diagnosed before the occurrence of PH.Trial registrationClinicalTrials, NCT03189602. Date of registration: June 16, 2017. Retrospectively registered.
Highlights
This study was performed to analyze the clinical manifestations, imaging features, and prognosis of Takayasu’s arteritis (TA) with pulmonary arteritis (PA)
Pulmonary hypertension (PH) is a late manifestation of PA that indicates a weaker response to treatment and a poor prognosis [3]; it is vital to achieve an early diagnosis of PA in patients with TA
PH was defined as an estimated pulmonary artery systolic pressure (PASP) of >50 mmHg and peak tricuspid regurgitation velocity (TRV) of >3.4 m/s, which suggests a high probability of PH according to the European Society of Cardiology/ European Respiratory Society PH guideline [11, 12]
Summary
This study was performed to analyze the clinical manifestations, imaging features, and prognosis of Takayasu’s arteritis (TA) with pulmonary arteritis (PA). TA can involve the pulmonary artery [3, 4]. The incidence of pulmonary arteritis (PA) in patients with TA varies greatly among studies (0–56%) [5, 6]. One Chinese hospital specializing in cardiovascular diseases reported that the incidence of PH in patients with TA involving the pulmonary artery reached 78.1% [8]. Pulmonary artery involvement in patients with TA increases the likelihood of misdiagnosis or delayed diagnosis because of the nonspecific respiratory manifestations and lack of symptoms of systemic vessel involvement [9]. PH is a late manifestation of PA that indicates a weaker response to treatment and a poor prognosis [3]; it is vital to achieve an early diagnosis of PA in patients with TA
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