Active Takayasu Arteritis Research Articles

Comparison of methotrexate and azathioprine as the first-line steroid-sparing immunosuppressive agents in patients with Takayasu's arteritis

BackgroundImmunosuppressive (IS) agents are recommended for the first-line treatment of patients with active Takayasu's arteritis (TAK) together with glucocorticoids (GCs). However, there is limited data comparing the efficacy and outcomes of different IS agents for this purpose. ObjectivesIn this study, we aimed to compare the outcomes of two most frequently used first-line IS agents, namely methotrexate (MTX) and azathioprine (AZA) in TAK patients. MethodsTAK patients who received any IS agent in addition to GCs as the initial therapy were included in this multicentre, retrospective cohort study. Clinical, laboratory and imaging data of the patients were assessed. In addition, a matched analysis (cc match) using variables ‘age’, ‘gender’ and ‘diffuse aortic involvement’ was performed between patients who received MTX or AZA as the first-line IS treatment. ResultsWe recruited 301 patients (F/M: 260/41, mean age: 42.2 ± 13.3 years) from 10 tertiary centres. As the first-line IS agent, 204 (67.8 %) patients received MTX, and 77 (25.6 %) received AZA. Less frequently used IS agents included cyclophosphamide in 17 (5.6 %), leflunomide in 2 (0.5 %) and mycophenolate mofetil in one patient. The remission, relapse, radiographic progression and adverse effect rates were similar between patients who received MTX and AZA as the first-line IS agent. Vascular surgery rate was significantly higher in the AZA group (23% vs. 9 %, p = 0.001), whereas the frequency of patients receiving ≤5 mg/day GCs at the end of the follow-up was significantly higher in the MTX group (76% vs 62 %, p = 0.034). Similarly, the rate of vascular surgery was higher in AZA group in matched analysis. Drug survival was similar between MTX and AZA groups (median 48 months, MTX vs AZA: 32% vs 42 %, p = 0.34). IS therapy was discontinued in 18 (12 MTX, 6 AZA) patients during the follow-up period due to remission. Among those patients, two patients had a relapse at 2 and 6 months, while 16 patients were still on remission at the end of a mean 69.4 (±50.9) months of follow-up. ConclusionsRemission, relapse, radiographic progression and drug survival rates of AZA and MTX were similar for patients with TAK receiving an IS agent as the first-line f therapy. The rate of vascular surgery was higher and the rate of GC dose reduction was lower with AZA compared to MTX at the end of the follow-up.

Are monocyte-to-HDL and C-reactive protein-to-albumin ratios useful for the diagnosis and follow-up of Takayasu arteritis?

In this study, we aimed to investigate the role of erythrocyte sedimentation rate, C-reactive protein, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio, red blood cell distribution width, mean platelet volume, monocyte/HDL ratio, and C-reactive protein/albumin ratio in the diagnosis and treatment follow-up of active and remission Takayasu arteritis patients compared with healthy control group. This is a retrospective case-control study in which 56 Takayasu arteritis patients and 40 age- and sex-matched healthy control were included. The blood values of Takayasu arteritis patients were analyzed during their active period and post-treatment remission periods, after comparing them with the healthy control. Furthermore, all parameters were evaluated by receiver operating characteristic analysis. Erythrocyte sedimentation rate, C-reactive protein, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio, monocyte/HDL ratio, and C-reactive protein/albumin ratio values were significantly higher in active Takayasu arteritis patients compared with healthy control and remission Takayasu arteritis groups. In the receiver operating characteristic analysis performed in active Takayasu arteritis and Takayasu arteritis patients in remission, C-reactive protein had the highest power to indicate disease activity, followed by C-reactive protein/albumin ratio, erythrocyte sedimentation rate, and monocyte/HDL ratio. When Takayasu arteritis in remission was compared with the healthy control, a significant difference was found between erythrocyte sedimentation rate, C-reactive protein, red blood cell distribution width, and C-reactive protein/albumin ratio, while no significant difference was found between monocyte/HDL ratio values. C-reactive protein/albumin ratio and red blood cell distribution width can be used in the diagnosis of Takayasu arteritis, and C-reactive protein/albumin ratio, red blood cell distribution width, and monocyte/HDL ratio measurements can be used in the follow-up. As C-reactive protein/albumin ratio is more powerful than C-reactive protein in differentiating the Takayasu arteritis group from the healthy control group, evaluation of C-reactive protein/albumin ratio together with albumin instead of evaluation of C-reactive protein alone when diagnosing the disease may help us to obtain more accurate results in daily practice.

Metabolic inflammatory volume and total inflammatory glycolysis: novel parameters to evaluate PET-CT disease activity in Takayasu arteritis.

To evaluate diagnostic accuracy for active Takayasu arteritis (TAK) for two novel 18F-fluorodeoxyglucose PET-CT parameters, the inflammatory volume (MIV) and total inflammatory glycolysis (TIG), to quantitate volume of metabolically-active arterial tissue. From a cohort of TAK (n = 36, 35 immunosuppressive-naïve), images of PET-CTs were reviewed for mean and maximum standardized uptake value (SUVmean and SUVmax), target-to-blood pool ratio (TBR), target-to-liver ratio (TLR), and PET Vasculitis Activity Score (PETVAS). Regions of interest were drawn to semiautomatically calculate MIV in areas of 18F-fluorodeoxyglucose uptake ≥ 1.5 SUVmean after excluding physiological tracer uptake. TIG was calculated by multiplying MIV with SUVmean. PET-CT parameters, ESR, CRP, and clinical disease activity scores were compared against the gold standard of physician global assessment of disease activity (PGA, active/inactive). Using dichotomized cut-offs for active TAK at SUVmax (≥ 2.21), SUVmean (≥ 1.58), TBR (≥ 2.31), TLR (≥ 1.22), PETVAS (various cut-offs), ESR (≥ 40mm/hour), and CRP (≥ 6mg/L), the novel indices MIV (≥ 1.8) and TIG (≥ 2.7) performed similar [area under the receiver operating characteristics curve (AUC) 0.873 for both] to SUVmax (AUC 0.841) and SUVmean (AUC 0.851), and better than TBR (AUC 0.773), TLR (AUC 0.773), PETVAS [≥ 5.5 (AUC 0.750), ≥ 10 (AUC 0.636), ≥ 15 (AUC 0.546)], ESR (AUC 0.748), or CRP (AUC 0.731). MIV and TIG had similar agreement with PGA or CRP as with SUVmax or SUVmean, and better agreement than TBR, TLR, or PETVAS cut-offs. MIV and TIG performed similarly, therefore, are viable alternatives to existing PET-CT parameters to assess TAK disease activity in this preliminary report. Key Points • MIV and TIG performed similar to SUVmax and SUVmax for disease activity assessment in TAK. • MIV and TIG distinguished active TAK better than TBR, TLR, PETVAS cut-offs, ESR, or CRP. • MIV and TIG had better agreement with PGA or CRP than TBR, TLR, or PETVAS cut-offs.

Evaluation of Takayasu's arteritis activity by ultrasound localization microscopy

Abstract Objectives Use of sulphur hexafluoride microbubbles (MB) with ultrasound can provide arterial wall enhancement. The use of ultrafast imaging with MB super-localization offers the possibility of ultrasound localization microscopy (ULM) and thus a visualization of in vivo carotid vasa vasorum. We aim to perform in vivo Vasa vasorum imaging in the carotid wall in Takayasu's arteritis and to provide a correlation with the disease's activity. Methods Patients with Takayasu arteritis were consecutively included in the national referral centre. Assessment of activity was performed by NIH activity index, with measurement of biological inflammation, morphological evaluation by computed tomography (CT) angiography, and 18-fluorodeoxyglucose CT scan. Ultrafast ultrasound imaging was performed with a 7 MHz central frequency linear probe. A dedicated contrast imaging sequence (plane waves with 8 angles, frame rate 500 Hz, voltage 8 V, duration of 8 s), coupled with the intravenous injection of sulphur hexafluoride MB allow us to store the raw radio frequency data of the MB passage. After a pre-processing step to accumulate frames properly including a frames selection and a movement correction, the MB were localized then tracked, allowing reconstruction of the vasa vasorum. The inflammation was quantified through MB tracked and normalized for inter acquisition comparison. Results 16 patients were included. 5 patients (median age 35.8 [24.5–46.0] years, 3 women) had active disease and 11 patients (37.2 [31.7–47.3] years, 9 women) had quiescent disease. The passage of MB allowed the visualisation of microvessels within the arterial wall for active cases. The number of MB detected per second in the wall was 118 [80–169] for active cases vs. 13 [10–15] for quiescent cases (p=0.0005). Conclusion ULM allows visualization of microvessels within the carotid wall, with significantly greater MB passage in active Takayasu arteritis. ULM provides for the first time a precise visualization in vivo of the vasa vasorum and gives access to quantification of the vascularity of the arterial wall. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Société française de cardiologie

Optic disk anatomical features of children with central retinal vein occlusion

To report a case series of children with central retinal vein occlusion (CRVO) showing a high prevalence of crowded optic disks with minimal cupping. We retrospectively reviewed the medical records of children diagnosed with CRVO from 2008 to 2019 at a single tertiary care pediatric hospital. Clinical records, fundus photographs, and optical coherence tomography (OCT) images were reviewed. Optic disk anatomical parameters of the unaffected fellow eyes, including OCT-measured optic disk area and vertical cup:disk ratio, were collected and analyzed. Six patients with unilateral CRVO were identified. All patients were female. Age at presentation ranged between 9 and 17years. Five patients were otherwise healthy, with negative systemic investigations (idiopathic group). The remaining patient had a known systemic risk factor of active Takayasu arteritis. Within the idiopathic group, "disk-at-risk" optic nerve configuration, defined as a cup:disk ratio of 0.2 or smaller, was identified in the fellow eye of all 5 patients. In the unaffected eyes, mean OCT-measured optic disk area was 1.67±0.13mm2 and mean cup:disk ratio was 0.19±0.12. The patient with Takayasu arteritis had normal OCT disk area of 2.1mm2 and cup:disk ratio of 0.61. We observed a high prevalence of anatomical features potentially consistent with a constrictive optic disk configuration in pediatric patients with CRVO.

Plasma proteomic screening and validation of novel biomarkers in Takayasu's arteritis.

To screen and validate differential proteins as novel biomarkers in active Takayasu's arteritis (TAK). Plasma samples from 40 active, 40 inactive patients, and 40 healthy controls were collected. Protein profiles of plasma were mapped by two-dimensional gel electrophoresis. Differential protein spots were detected and identified by image analysis and mass spectrometry. Plasma concentrations of proteins were measured to validate candidate biomarkers. The area under the receiver operating characteristic (ROC) curve (AUC) of circulating plasma concentrations of candidate biomarkers were calculated to assess diagnostic value. With a total of 1507 matched gel spots, there were 170 differential expression spots between active and inactive TAK, including 139 up-regulated and 31 downregulated. Only 11 proteins could be identified by mass spectrometry. Serum amyloid A(SAA), fibrinogen, complement C4a, complement C3c, complement C4b binding protein(C4bp), recombination acting gene protein 1(RAG1), alpha-1-acid glycoprotein, alpha-1-microglobulin, complement C7, complement factor H related protein-1 were up-regulated in active patients, while serum amyloid P was down-regulated. Active patients had higher circulating levels of RAG1(P<0.001), C4bp (p=0.012) and SAA (p<0.001), compared to inactive patients, while inactive patients had higher levels than controls (RAG1, p=0.011; C4bp, p=0.012; SAA, p=0.005). The composite AUC with SAA, RAG1, and C4bp was 0.94 (95%CI 0.86-0.98) for discriminating activity, larger than 0.71(95% CI 0.60-0.80) for ESR (p=0.0004) or 0.75(95%CI 0.64-0.84) for CRP (p=0.0014), respectively. Some acute-phase and immunology-related proteins may serve as novel biomarkers of TAK. Further study of these proteins may be helpful to elucidate the pathologic mechanism.

Detection of mural inflammation with low b-value diffusion-weighted imaging in patients with active Takayasu Arteritis.

To evaluate the performance of low b-value diffusion-weighted imaging (DWI) for detection of inflamed vessels in active Takayasu arteritis (TA). Forty patients with active TA involving the thoracic aorta and its super-aortic branches underwent low b-value (50 s/mm2) DWI, T2-weighted imaging (T2WI), and delayed enhancement T1-weighted imaging (DEI). Corresponding images on these 3 sequences at the same diseased level were evaluated qualitatively and quantitatively using Friedman and Kruskal-Wallis test, and the agreement between them in detection of inflamed vessels was assessed using Cochran's Q test. The overall image quality of DEI, DWI, and T2WI was scored 7.97 ± 1.15, 7.32 ± 1.73, and 6.51 ± 1.69 respectively. The score of DEI and DWI was higher than that of T2WI (p < 0.001). The quality of blood suppression was rated higher in DWI than T2WI and DEI (p < 0.001). Both the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the diseased vessel walls measured on DEI and DWI were significantly higher than those on T2WI (p < 0.001). However, there was no significant difference in SNR and CNR between DEI and DWI (p = 0.283 and 0.063). In detection of mural inflammation, significant advantage was observed when comparing the findings from DEI/DWI to those from T2WI (p < 0.001). But no significant difference was found between the findings of DWI and DEI (p > 0.99). Low b-value DWI may be used as a promising alternative to DEI for detecting inflamed vessels in active TA. • Currently, the most widely used imaging modality in detection of mural inflammation is contrast-enhanced MRI. • Low b-value DWI is shown comparable to contrast-enhanced MRI and superior to T2WI in identifying mural inflammation in patients with active Takayasu arteritis. • Low b-value DWI is a fast and unenhanced MRI technique which may potentially replace contrast-enhanced MRI in identifying disease activity of Takayasu arteritis.

Pentraxin 3 is more accurate than C-reactive protein for Takayasu arteritis activity assessment: A systematic review and meta-analysis.

AimsWhether the circulating levels of pentraxin 3 (PTX3), an acute phase reactant (APR), are higher in active Takayasu arteritis (TAK), and if so, whether PTX3 is more accurate than C-reactive protein (CRP) in TAK activity assessment has been investigated in this study.Study designResearch works such as PubMed, Embase, ScienceDirect, Cochrane Library, and two Chinese literature databases (CNKI and WanFang) were searched for studies conducted till August 30th, 2019. Two investigators searched the studies independently, who evaluated the quality of the study using the Newcastle–Ottawa scale (NOS) and extracted data. Pooled standard mean difference (SMD) and diagnostic indexes, with a 95% confidence interval (CI), were calculated using a random-effect model.ResultsTotally, 8 studies involving 473 TAK (208 active and 265 inactive TAK) patients and 252 healthy controls were eventually included in the meta-analysis. PTX3 level in the blood in active TAK patients were found to be higher than that in dormant TAK with pooled SMD of 0.761 (95% CI = 0.38–1.14, p<0.0001; I2 = 68%, p of Q test = 0.003). And there was no publication bias. Among the 8 studies, 5 studies identified active TAK with both PTX3 and CRP. The pooled sensitivity, specificity, and AUC values of PTX3 in active TAK diagnosis were higher than those of CRP (0.78 [95% CI = 0.65–0.87] vs. 0.66 [95% CI = 0.53–0.77], p = 0.012; 0.85 [95% CI = 0.77–0.90] vs. 0.77 [95% CI = 0.56–0.90], p = 0.033; 0.88 [95% CI = 0.85–0.90] vs. 0.75 [95% CI = 0.71–0.79], p < 0.0001). It showed potential publication bias using Egger’s test (p of PTX3 = 0.031 and p of CRP = 0.047).ConclusionsPTX3 might be better than CRP in the assessment of TAK activity. Yet, it should be cautious before clinical use for moderate heterogeneity and potential publication bias of the meta-analysis.

Takayasu arteritis: clinical importance of extra-vessel uptake on FDG PET/CT

Background[F-18]fluorodeoxyglucose positron emission tomography/computed tomography is routinely used for assessing Takayasu arteritis patients. However, extra-vessel [F-18]fluorodeoxyglucose uptake has not been evaluated in detail in these patients. We aimed to describe the extent and distribution of extra-vascular [F-18]fluorodeoxyglucose uptake on positron emission tomography/computed tomography in Takayasu arteritis patients. Seventy-three [F-18]fluorodeoxyglucose positron emission tomography/computed tomography scans from 64 consecutive Takayasu arteritis patients (59 women, mean age, 35.4 years; range, 13 to 71 years) and 40 scans from age-matched controls (36 women, mean age, 37.8 years; range, 13 to 70 years) were examined. We graded [F-18]fluorodeoxyglucose uptake in large vessels using a 4-point scale and evaluated extra-vessel findings. Factors correlated with disease activity were examined. We evaluated the relationship between disease activity according to the National Institutes of Health score with extra-vessel findings, as well as other inflammatory markers (e.g., white blood cell count and C-reactive protein level).ResultsExtra-vessel involvement was present in 50 of 73 (68.4%) scans, specifically at the following sites: lymph nodes, 1.4%; thyroid glands, 17.8%; thymus, 11.0%; spleen, 1.4%; vertebrae, 45.2%; and pelvic bones, 9.6%. Takayasu arteritis patients had higher [F-18]fluorodeoxyglucose uptake in the spine (P = 0.03) and thyroid glands (P = 0.003) than did controls; uptake in other regions was comparable between groups. Compared with inactive patients, those with active Takayasu arteritis had a higher number of [F-18]fluorodeoxyglucose uptake sites in the vasculature (P = 0.001). Finally, patients with a National Institutes of Health score of ≥ 1 had significantly higher extra-vascular involvement (P = 0.008).ConclusionsExtra-vessel [F-18]fluorodeoxyglucose uptake may be present in the context of Takayasu arteritis-related inflammatory processes. Information on extra-vascular [F-18]fluorodeoxyglucose uptake may be useful for detecting and evaluating inflammatory processes when interpreting positron emission tomography/computed tomography scans obtained from Takayasu arteritis patients.

The C-Reactive Protein/Albumin Ratio and Complete Blood Count Parameters as Indicators of Disease Activity in Patients with Takayasu Arteritis.

BackgroundThis study aimed to evaluate the ratio of C-reactive protein (CRP) to albumin, inflammatory markers, and parameters from the complete blood count (CBC) in patients with Takayasu arteritis and the association with disease activity.Material/MethodsA retrospective study included thirty-two patients with Takayasu arteritis and 32 healthy controls. Clinical and demographic characteristics of patients with Takayasu arteritis were recorded at baseline, before medication and on remission. Similar data were obtained for the controls at recruitment. Remission was defined as more than six months of stable disease without new vascular lesions in patients who previously had active disease. Kerr’s criteria were used to define active Takayasu arteritis.ResultsIn patients with Takayasu arteritis, the erythrocyte sedimentation rate (ESR), CRP, CRP/albumin ratio, red cell distribution width (RDW), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte-lymphocyte ratio (MLR) were significantly higher, and albumin and MPV were significantly lower compared with controls. The ESR, CRP, CRP/albumin ratio, NLR, PLR, and MLR were decreased in remission, whereas MPV was increased. CRP and the CRP/albumin ratio were positively correlated and albumin and MPV were negatively correlated with disease activity. The CRP/albumin ratio had the highest correlation with disease activity in Takayasu arteritis. The CRP/albumin ratio, RDW, NLR, PLR, and MLR were positively correlated with CRP and ESR.ConclusionsThe CRP/albumin ratio, RDW, NLR, PLR, MLR, and MPV were markers of remission of active disease, and the CRP/albumin ratio, total albumin, and MPV were markers of disease activity in Takayasu arteritis.

Atypical Presentation of Takayasu's Arteritis—A Case Report

AbstractTakayasu's arteritis, known as “pulseless disease,” is a chronic idiopathic inflammatory disease, which has a greater predilection for large vasculature in the body. Initially described in the1800s, this rare condition is more commonly seen in Asian women in 40 years age group. Herein, the authors report the case of a 36-year-old woman whose exertional claudication was the initial manifestation of active Takayasu's arteritis along with involvement of multiple peripheral arteries not involving ostial area of the vessels, instead affecting the proximal area and also presenting with thrombosis of right CIA (common iliac artery), which is an unusual presentation in case of Takayasu's arteritis without aneurysmal involvement.

Infliximab biosimilar CT-P13 therapy in patients with Takayasu arteritis with low dose of glucocorticoids: a prospective single-arm study

To evaluate the efficacy and safety of infliximab biosimilar CT-P13 in patients with active Takayasu arteritis (TAK). In this single-center open-label trial, patients with active TAK received CT-P13 at a starting dose of 5 mg/kg at weeks 0, 2, 6, and then every 8 weeks up to week 46. They were followed up until week 54. From week 14 to week 46, patients with inadequate response received increased dose of CT-P13 by 1.5 mg/kg. Concomitant prednisolone was allowed ≤ 10 mg/day. The primary efficacy end point was the achievement of partial or complete remission at week 30. All patients underwent positron emission tomography–computed tomography (PET–CT) at baseline and week 30. Twelve patients with TAK received CT-P13; one patient with protocol violation was excluded from analysis. Nine (81.8%) patients had taken concomitant prednisolone with median dose of 5.0 mg/day. At week 30, three (27.3%) patients achieved complete remission and six (54.5%) patients achieved partial remission. Statistically significant improvements in modified Indian Takayasu Clinical Activity Score (ITAS2010), ITAS-A, and serum levels of erythrocyte sedimentation rate and C-reactive protein were seen at week 30 from baseline. PET parameters were significantly reduced from baseline to week 30, including maximum standardized uptake value, target-to-vein ratio, target-to-liver ratio, and PET Vascular Activity Score. There were no serious adverse events. Treatment with CT-P13 may lead to improvement in clinical, radiographic, and serological activities with lower glucocorticoid requirement in TAK.Trial registration number NCT02457585.

Comparison between visual and numerical metrics for the evaluation of patients with Takayasu arteritis with 18F-FDG-PET

The choice of metrics for defining active Takayasu arteritis (TAK) using fluorine-18-fluorodeoxyglucose (F-FDG)-PET remains controversial. The aim of this study was to compare in the same patients the diagnostic performance for the detection of active TAK of different metrics applied for the quantification of vascular F-FDG uptake with PET. Overall, 62 PET acquisitions were performed 90 min after F-FDG injection in 15 patients with TAK and analyzed retrospectively. The intensity of vascular F-FDG uptake was graded visually in comparison with the liver signal and with the numerical metrics, including maximum standard uptake value (SUV), maximum target to background ratio (TBR, ratio of SUVmax in the vessel wall and SUVmean of blood), most-diseased segment (MDS)-TBR (average of TBR from all active lesions), and global TBR (average TBR along the aorta and carotid arteries). The gold standard was disease activity identified using the National Institute of Health score for TAK. Using visual analysis, the definition of F-FDG-PET as positive in presence of at least one vascular lesion with a signal more than liver provided the best diagnostic performance for detecting active TAK with a specificity of 98%, a sensitivity of 62% and an accuracy of 89%. Using numerical metrics, SUVmax [SUVmax >3.3; area under the curve (AUC)=0.84] and TBRmax (TBRmax >2.3; AUC=0.84) offered the best diagnostic performance for the detection of active TAK in comparison with MDS-TBR (MDS-TBR>1.7; AUC=0.70) and global TBR (global TBR >1.4; AUC=0.51). In this study, we found that the analysis of the vascular region with the highest F-FDG uptake using either visual or numerical metrics provided the best diagnostic performance for the detection of active TAK with PET.

C-reactive protein gene polymorphisms (rs1205) in Asian Indian patients with Takayasu arteritis: Associations and phenotype correlations.

Normal C-reactive protein (CRP) in active Takayasu arteritis (TA) is a dilemma. We attempted to validate our pilot study finding of rs1205 in CRP gene being protective against TA. Genomic DNA of 104 patients and 185 sex-matched healthy controls were genotyped for rs1205 by Taqman assay. Clinical details, demography, angiographic and activity scores (Indian Takayasu arteritis score 2010) were recorded prospectively at baseline and during follow-up visits for 12 months. Minor allele frequency (MAF) and genotype distribution between patients and controls as well as patient subgroups were compared using χ2 test with Bonferroni correction (pc ) and logistic regression was performed to determine independent associations. The majority of patients (n = 84) and controls (n = 166) were females. MAF of T allele of rs1205 was less frequent in patients (27%) as compared to controls (37.6%), P = 0.013, pc = 0.026 with an odds ratio of 0.632 irrespective of gender. Frequency of CC genotype was higher in cases (53.8%) than controls (37.3%), P = 0.006, pc = 0.018. A dominant model of genotype-phenotype association revealed CC to be associated with more frequent coronary arterial and ascending aorta involvement than the other genotypes clubbed together (P = 0.01 and P = 0.014, respectively). Blunted CRP response seems to be less frequent in patients with CC genotype (P = 0.064). T allele of rs1205 in CRP gene was less frequent in TA. CC genotype was associated with involvement of coronary arteries and ascending aorta. CC genotype was less commonly associated with blunted CRP response (CT + TT > CC).

The role of mean platelet volume in patients with Takayasu arteritis.

Background Takayasu arteritis is a chronic non-specific inflammatory disease and mean platelet volume can either be decreased or increased during inflammation. However, there are no published data to confirm an association between mean platelet volume and Takayasu arteritis. Our aim was to evaluate the role of mean platelet volume in patients with Takayasu arteritis. Methods A total of 119 consecutive patients with Takayasu arteritis and 217 healthy individuals were included in this study. Forty-five Takayasu arteritis patients with active disease were followed with prednisone therapy. Results Mean platelet volume of patients was low compared with control groups (10.1 ± 1.47 fL vs. 11.2 ± 0.91 fL; P < 0.001). Mean platelet volume was lower in active Takayasu arteritis than in inactive Takayasu arteritis patients (9.3 ± 1.39 fL vs. 10.6 ± 1.28 fL; P< 0.001). Mean platelet volume values were significantly increased after prednisone treatment (9.3 ± 1.45 fL vs. 10.5 ± 1.29 fL; P < 0.001). Mean platelet volume negatively correlated with C-reactive protein, erythrocyte sedimentation rate, neutrophil count and platelet count (r = - 0.219, P = 0.018; r = - 0.296, P < 0.001; r = - 0.273, P = 0.003; r =-0.486, P< 0.001), and positively correlated with platelet distribution width (r=0.304, P ≤ 0.001) in patients with Takayasu arteritis. An inverse correlation between mean platelet volume and erythrocyte sedimentation rate was observed in active Takayasu arteritis patients (r = -0.406, P = 0.010). In multiple linear regression analysis, mean platelet volume was independently correlated with erythrocyte sedimentation rate in patients with Takayasu arteritis. Conclusions Our results suggest that mean platelet volume may identify active disease in patients with Takayasu arteritis, and the values of mean platelet volume may help to establish remission of active disease after treatment in Takayasu arteritis patients.

Takayasu Arteritis Involving Multiple Peripheral Arteries of a 37-year-old Female: A Case Report and Brief Overview

Takayasu arteritis, formerly known as “pulseless disease”, is a chronic idiopathic vasculitis which affects the large vessels in the body. First described in the 1800’s, this rare condition is more commonly found in Asian women in their 40’s. Herein, we report the case of a young woman whose exertional angina and claudication were the initial presentation of active Takayasu arteritis. The importance of modern technology of imaging such as CT, MRI and angiography, can often have paramount importance for confirming a diagnosis and the extent of the pathology. Newer modalities of investigation helps in evaluation of vascular involvement and its haemodynamic effects on cardiovascular system. Previously majority of patient had to be diagnosed clinically. Now a days by CT peripheral Angiogram this disease can be diagnosed. Invasive procedure of peripheral Angiogram is troublesome but single IV dye injection can revealed the actual scenario. So it has got important scientific value.Bangladesh Heart Journal 2015; 30(2) : 92-95

Management and timing of aortic replacement for aneurysmal disease in a 25 year-old female with active Takayasu's Arteritis

Management and timing of aortic replacement for aneurysmal disease in a 25 year-old female with active Takayasu's Arteritis

Association of abnormal lipid spectrum with the disease activity of Takayasu arteritis.

Our study aimed to determine whether proatherogenic lipid profiles exist in patients with active Takayasu arteritis (TA) and assess the relationship between different lipid profiles and disease activity in TA. A total of 132 premenopausal female patients with TA and 100 sex-, age-, and body mass index-matched healthy controls were included in our study. The clinical data were collected in detail from all participants. Patients with active TA had significantly lower levels of apolipoprotein A1 (apoA1) (1.47 ± 0.30 vs. 1.99 ± 0.33 mmol/L, p < 0.001) and lower levels of high-density lipoprotein cholesterol (HDL-C) (1.23 ± 0.33 vs. 1.68 ± 0.38 mmol/L, p < 0.001) than patients with inactive TA. However, they had higher ratios of apolipoprotein B (apoB)/apoA1 (0.74 ± 0.27 vs. 0.48 ± 0.14, p < 0.001) compared with patients with inactive TA. Multiple linear regression analysis demonstrated that the apoB/apoA1 ratio was independently associated with TA activity (β = 0.38, p = 0.04). In addition, multivariate stepwise forward regression analysis showed that the apoB/apoA1 ratio was the major determinant for high-sensitivity C-reactive protein (β = 0.58, p = 0.002). Our findings indicate that patients with active TA had proatherogenic lipid profiles. In addition, the ratio of apoB to apoA1 could be used as a marker for monitoring and targeting patients with TA.

Analysis of pregnancies in women with Takayasu arteritis: complication of Takayasu arteritis involving obstetric or cardiovascular events.

The incidence of Takayasu arteritis during child-bearing years is relatively high. The management of pregnancies in patients with this disease is of great importance in clinical obstetrics. Here we analyzed pregnancies of women with Takayasu arteritis with and without complications. We retrospectively identified 27 pregnancies in 20 women with Takayasu arteritis seen between 1983 and 2005 at the National Cardiovascular Center, in Osaka, Japan. The incidences of obstetric events, steroid dose increase in pregnancy, and cardiovascular events were compared between group I (no complications), group II (one complication), and group III (two or more complications). None of the pregnancies showed Takayasu arteritis activity. The obstetric events were pre-eclampsia in four pregnancies (15%), fetal growth restriction in one (4%), and abruption in one (4%). Three pregnancies involved a steroids dose increase. There were no cardiovascular events. Eighty percent of the pregnancies that included an obstetric event also involved the mother's chronic hypertension. Pregnant women without active Takayasu arteritis have a low risk of developing a cardiovascular event. For women with chronic hypertension, it might be important to note the development of pre-eclampsia, fetal growth restriction and abruption.

Retinal hemorrhage as a unique ophthalmic manifestation of cerebral hyper perfusion syndrome

Cerebral hyperperfusion syndrome (CHPS) is a rare, complication of carotid artery revascularization. Acute retinal hemorrhage is a very rare entity previously described as a manifestation of CHPS following carotid artery stenting (CAS), but to the best of our knowledge, not yet described as a complication of carotid surgery. An Ascending Aorta to bilateral Carotid bypass was performed in a 35-year-old woman with active Takayasu arteritis and 95% symptomatic stenosis of both common carotid arteries. Severe retinal hemorrhage appeared on the second post operative day combined with high blood pressure, brain edema on CT scan and grand mal seizures. It seems that fundoscopic examination following carotid revascularization of tight can be helpful in identifying those patients who develop symptoms suggesting of CHPS.