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. 2025 Sep;114(9):1216-1231.
doi: 10.1007/s00392-025-02728-y. Epub 2025 Aug 25.

Cardiac disease in patients with vasculitis

Leonhard Binzenhöfer #  1 , Katharina Strauß #  1 , Linus Seifert  1 , Inas Saleh  1 , Marie Scherzer  2 , Julia Höpler  2 , Didzis Gailis  3 , Christina Gebhard  3 , Julia Lichtnekert  3 , Fabian Ullrich  3 , Delila Singh  3 , Torben Sonneck  3 , Matthias Thaler  3 , Sebastian Zimmer  4 , Steffen Massberg  1 , Holger Thiele  5 , Valentin Sebastian Schäfer  6 , Georg Nickenig  4 , Michael Czihal  7 , Hendrik Schulze-Koops #  8 , Enzo Lüsebrink #  9
Affiliations

Cardiac disease in patients with vasculitis

Leonhard Binzenhöfer et al. Clin Res Cardiol. 2025 Sep.

Abstract

Background: Cardiac involvement has been described in many forms of vasculitides and is associated with worse outcomes. However, data on the incidence of structural and arrhythmic heart disease is limited.

Methods: For this single-center study, we recruited 191 patients with giant-cell arteritis (GCA, n = 109), Takayasu arteritis (TAK, n = 26), polyarteritis nodosa (PAN, n = 3), granulomatosis with polyangiitis (GPA, n = 38), or eosinophilic granulomatosis with polyangiitis (EGPA, n = 15) between August 2023 and January 2025. The primary study endpoint was the incidence of structural or arrhythmic heart disease after the diagnosis of vasculitis.

Results: The demographic characteristics of patients diagnosed with vasculitis differed significantly between those with GCA, TAK, PAN, GPA, and EGPA. Arterial hypertension and dyslipidemia at baseline were more prevalent among patients with GCA, while chest pain and signs of congestion were more frequently reported by patients with EGPA. No significant difference between the five main subgroups were found regarding the incidence of documented arrhythmic diseases. Cardiac imaging was performed using echocardiography in 70% of the overall cohort and cardiac magnetic resonance (CMR) in 11%. CMR detected left ventricular systolic dysfunction and myocardial fibrosis in 33% and 40% of EGPA patients, respectively. All four cases of acute myocardial infarction occurred in patients with GCA. Among 19 GCA patients who underwent coronary angiography, 21.1% underwent percutaneous coronary intervention. In the EGPA group, coronary angiography was performed in 46.7% of patients, but none required percutaneous intervention. A substantial proportion of patients was treated with acetylsalicylic acid (50.3%), beta-blockers (41.9%), or ACE-inhibitors/AT1-receptor antagonists (60.2%).

Conclusion: Severe cardiac complications occurred rarely, although cardiovascular risk factors, structural abnormalities, and arrhythmias affected a substantial proportion of patients with vasculitis, highlighting the potential benefit of systematic screening and multidisciplinary management.

Keywords: Cardiac arrhythmia; Structural heart disease; Vasculitis.

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Conflict of interest statement

Declarations. Ethical standards: All ethical standards were met in writing and submitting this correspondence. Conflicts of interest: None. Data sharing agreement: The data are not publicly available due to ethical restrictions and legal constraints. Readers may contact the corresponding authors for reasonable requests for the data. De-identified data may be provided after approval from the ethical review board.

Figures

Fig. 1
Fig. 1
Study flowchart. EGPA, eosinophilic granulomatosis with polyangiitis; GCA, giant cell arteritis; GPA, granulomatosis with polyangiitis; PAN, polyarteritis nodosa; TAK, Takayasu arteritis
Fig. 2
Fig. 2
Diagnostic procedures and findings. CAD, coronary artery disease; EGPA, eosinophilic granulomatosis with polyangiitis; GCA, giant cell arteritis; GPA, granulomatosis with polyangiitis; PAN, polyarteritis nodosa; TAK, Takayasu arteritis
Fig. 3
Fig. 3
Cardiovascular medication. ACE, angiotensin converting enzyme; ASA, acetyl salicylic acid; AT, angiotensin; EGPA, eosinophilic granulomatosis with polyangiitis; GCA, giant cell arteritis; GPA, granulomatosis with polyangiitis; PAN, polyarteritis nodosa; TAK, Takayasu arteritis
See this image and copyright information in PMC

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