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. 2021 Dec 3;23(1):293.
doi: 10.1186/s13075-021-02675-9.

The clinical features of pulmonary artery involvement in Takayasu arteritis and its relationship with ischemic heart diseases and infection

Hiroki Mukoyama  1 , Mirei Shirakashi  1 , Nozomi Tanaka  1 , Takeshi Iwasaki  1 , Toshiki Nakajima  2 , Hideo Onizawa  3 , Hideaki Tsuji  1 , Koji Kitagori  1 , Shuji Akizuki  1 , Ran Nakashima  1 , Kosaku Murakami  1 , Masao Tanaka  3 , Akio Morinobu  1 , Hajime Yoshifuji  4
Affiliations

The clinical features of pulmonary artery involvement in Takayasu arteritis and its relationship with ischemic heart diseases and infection

Hiroki Mukoyama et al. Arthritis Res Ther. .

Abstract

Background: Pulmonary artery involvement (PAI) in Takayasu arteritis (TAK) can lead to severe complications, but the relationship between the two has not been fully clarified.

Methods: We retrospectively investigated 166 consecutive patients with TAK who attended Kyoto University Hospital from 1997 to 2018. The demographic data, clinical symptoms and signs, comorbidities, treatments, and imaging findings were compared between patients with and without PAI. TAK was diagnosed based on the American College of Rheumatology Classification Criteria (1990) or the Japanese Clinical Diagnostic Criteria (2008). PAI was identified using enhanced computed tomography, magnetic resonance imaging, or lung scintigraphy.

Results: PAI was detected in 14.6% (n = 24) of total TAK patients. Dyspnea (25.0% vs. 8.6%; p = 0.043), pulmonary arterial hypertension (PAH) (16.7% vs. 0.0%; p < 0.001), ischemic heart disease (IHD) (29% vs. 9.3%; p = 0.018), respiratory infection (25.0% vs. 6.0%; p = 0.009), and nontuberculous mycobacteria (NTM) infection (20.8% vs. 0.8%; p < 0.001) were significantly more frequent, and renal artery stenosis (0% vs. 17%; p = 0.007) was significantly less frequent in TAK patients with PAI than in those without PAI. PAI and biologics were risk factors for NTM.

Conclusions: TAK patients with PAI more frequently have dyspnea, PAH, IHD, and respiratory infection, including NTM, than TAK patients without PAI.

Keywords: Infection; Ischemic heart diseases; Pulmonary artery involvement; Takayasu arteritis.

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Conflict of interest statement

HM, MS, NT, TI, TN, HO, HT, KK, SA, RN, KM, and AM claimed no COI for this work. MT has received research grants and/or speaker fees from AbbVie GK, Asahi Kasei Pharma Corp., Astellas Pharma Inc., Ayumi Pharmaceutical Corp., Bristol-Myers Squibb, Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., Pfizer Inc., UCB Japan Co., Ltd., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Corp., Novartis Pharma K.K., Taisho Pharma Co., Ltd. HY has received lecture fees from Chugai pharmaceuticals and AbbVie, and advisory fees from Janssen pharmaceuticals. Department of Advanced Medicine for Rheumatic Diseases is supported by two local governments in Japan (Nagahama City, Shiga and Toyooka City, Hyogo) and five pharmaceutical companies (Mitsubishi Tanabe Pharma Corp., Chugai Pharmaceutical Co., Ltd., Ayumi Pharmaceutical Corp., Asahi Kasei Pharma Corp. and UCB Japan Co., Ltd.).

Figures

Fig. 1
Fig. 1
Representative pulmonary artery involvement images. Occlusion of the right upper pulmonary artery branches on enhanced computed tomography (CT) (a). Occlusion of the left main pulmonary artery on magnetic resonance angiography (b). The right main pulmonary artery vessel wall thickness (c) and stenosis of the lower pulmonary artery branches (d) on enhanced CT. Dilation of the right main pulmonary artery (e). Occlusion of the right pulmonary artery branches on enhanced CT (f) and angiography (g). A perfusion defect in the right lung (h)
Fig. 2
Fig. 2
Pulmonary artery involvement (PAI) and nontuberculous mycobacteria (NTM) disease imaging on computed tomography. Patient 1: occlusion of the right upper and middle pulmonary arterial branches (a) and a large opacity with a cavity in the right lower lobe and ill-defined nodules in bilateral lungs (b). Patient 2: occlusion of the right main pulmonary artery (c) and a large opacity in the right lower lobe (d). Patient 3: occlusion of the right upper and middle pulmonary artery branches (e) and a large opacity with a cavity in the right lung (f). Patient 4: dilation of the left pulmonary artery branches (g) and ill-defined nodules in the left upper lobe (h). Patient 5: occlusion of the left main pulmonary artery before developing NTM disease (i) and ill-defined nodules in the left lung (j). The left and right images of patients 2, 3, and 4 were taken simultaneously, since the previous images were not available. Patient 6 did not have PAI. Therefore, the images are not presented
Fig. 3
Fig. 3
Serious infection, respiratory infection, and nontuberculous mycobacteria (NTM) infection during the observation period. Kaplan-Meier graphs show the rate of developing serious infection, respiratory infection, and NTM infection in Takayasu arteritis (TAK) patients with or without pulmonary artery involvement (PAI) during the observation period. The y-axis represents the cumulative incidence of infection. Hazard ratio (HR) represents comparison of survival curves (PAI/without PAI) using log-rank test. CI: confidence interval
See this image and copyright information in PMC

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