Clinical manifestations of damage to the cardiovascular system and predictors of poor prognosis of Takayasu arteritis in Kyrgyz patients

Abstract

Damage to the cardiovascular system (CVS) in Takayasu arteritis (AT) is characterized by a wide range of clinical manifestations and an unfavorable prognosis of the disease. Objectives: determine the characteristics of clinical manifestations of damage to the CVS and predictors of unfavorable prognosis in Kyrgyz patients with АТ. Methods: The study included 135 patients with a reliable diagnosis of AT, verified according to the classification criteria of the American College of Rheumatology/The European Alliance of Rheumatology Associations (ACR/EULAR, American College of Rheumatology/European Alliance of Associations for Rheumatology). All patients underwent clinical and standard laboratory and instrumental examination. Results: CVC lesion was observed in 84.4% of patients with AT and was manifested mainly by secondary arterial hypertension (AH) and aortic regurgitation (AR) – 52.8% and 27.8% of cases, respectively. The main cause of secondary hypertension was renovascular hypertension (63.4%). Myocarditis (8.5%) and coronary syndrome (3.8%) were significantly less frequently diagnosed. Among the cardiovascular complications (CVc) that developed in 32.5% of patients, decompensated chronic heart failure (DCHF) (48.7%) and acute cerebrovascular accident (ACVA) were the most common (40,5%). The immediate cause of death in the observed cohort was DCHF (66.7%) due to severe AR (83.3%) and ischemic cardiomyopathy (16.7%). Predictors of the development of CVc were the V anatomical type of vascular lesion, high activity of the pathological process, severity of stenotic changes, serious clinical complications (CC) and severe AR (p<0.05). Conclusion: 1. CVS lesion was observed in 84.4% of Kyrgyz patients with AT. 2. The most frequent variant of cardiovascular pathology was secondary hypertension (52.8%) caused by vasorenal (63.4%), coarctation (33%) and aortic (3.6%) changes. The second most common was pathology of the aortic valve (27.8%) with a predominance of minor AR (45.8%). 3. CVc was observed in one third of patients (32.5%) and in most cases were presented with DCHF (48.7%) and ACVA (40.5%). 4. Unfavorable factors associated with an increased risk of CVc in the observed patients were V anatomical type of vascular lesion, high activity, pronounced stenotic changes, severe CC and severe AR (p<0.05).