MYOCARDIAL INVOLVEMENT IN TAKAYASU ARTERITIS PATIENTS ASSESSED BY MAGNETIC RESONANCE IMAGING AND ITS RELATION WITH DISEASE ACTIVITY

Background: Cardiac involvement in Takayasu arteritis(TA) is the major cause of morbidity and mortality. [1] Cardiovascular magnetic resonance (CMR) is an excellent modality for the assessment of myocardial involvement. Studies have shown subclinical myocardial scarring in 25-27% of patients.[2,3] There is no such study from India. Objectives: To evaluate the prevalence of myocardial involvement in TA, as detected by CMR and its correlation with disease activity score (ITAS 2010 and ITAS-A). Methods: Patients classified as Takayasu arteritis according to Sharma et al. criteria [4] were included after an informed consent. Demographic, clinical, laboratory data were documented in the predesigned proforma. CMR was done on a dedicated CMR machine. Disease activity was recorded by ITAS2010 and ITAS-A.[5] Ethical clearance has been obtained from the ethics committee of the institute (INT/IEC/2018/001538). Results: In the present study, 37 TA patients were included. Mean(±SD) age was 29 ±11 years. Female to male ratio was 3:1. The most frequent presenting symptom was upper limb claudication (49%), and vessel involved was left subclavian and descending thoracic aorta(75% each). Of the total cohort, 65% had hypertension, 35% had dyslipidemia and 19% had valvular involvement. Five patients (14%) had myocardial involvement as detected by CMR. Three (8%) patients had late gadolinium enhancement(LGE) on CMR suggestive of myocardial fibrosis. In the current study, both the CMR and echocardiography performed equally in detecting various valvular heart disease, whereas only CMR had detected subclinical myocardial fibrosis in two patients. Details of different risk factors and relation with disease activity provided in table 1. Conclusion: To the best of our knowledge, this is the largest cohort on CMR in TA. Prevalence of subclinical myocardial involvement in Indian patients was much less(8% vs 25-27%) compared to the previous studies. The higher percentage of LGE detected by the earlier studies may be a reflection of cumulative damage with increasing age, prolonged hypertension, and disease duration. Myocardial involvement trend towards early age of onset, less disease duration, lack of classical risk factors, and more with disease activity. Judicious use of CMR may help in detecting subclinical myocardial involvement. References: [1]Cong XL, Dai SM, Feng X et al. Takayasu’s arteritis: clinical features and out- comes of 125 patients in China. Clin Rheumatol 2010;29:973–81. [2]Keenan NG, Mason JC, Maceira A et al. Integrated cardiac and vascular assessment in Takayasu arteritis by cardiovascular magnetic resonance. Arthritis Rheum. 2009;60:3501-9. [3]Comarmond C, Cluzel P, Toledano D et. al. Findings of cardiac magnetic resonance imaging in asymptomatic myocardial ischemic disease in Takayasu arteritis. Am J Cardiol. 2014;113:881-7. [4]Sharma BK, Jain S, Suri S et al. Diagnostic criteria for Takayasu Arteritis. Int J Cardiol 1996;54: S141-7. [5]Misra R, Danda D, Rajappa SM, et al. Development and initial validation of the Indian Takayasu Clinical Activity Score (ITAS2010). Rheumatology 2013;52:1795-801. Disclosure of Interests: None declared