Xiongjing Jiang

Clinical Manifestations and Longterm Outcome for Patients with Takayasu Arteritis in China

Objective. To describe a large cohort of patients with Takayasu arteritis in China. Methods. We retrospectively analyzed 566 patients hospitalized in Fuwai Hospital between 2002 and 2013. Data collected were clinical characteristics, laboratory findings, angiographic features, treatment, and longterm outcome. Results. The female to male ratio was 3.8 to 1, and the mean age of onset was 28.9 ± 12.0 years. The most common inflammatory symptom, initial symptom, and coexisting disease were fever (52, 9.2%), dizziness (214, 37.8%), and hypertension (HTN; 392, 69.3%), respectively. Pulmonary artery, coronary artery involvement, and aortic regurgitation were found in 83 (14.7%), 66 (11.7%), and 181 (36.7%) patients, respectively. Elevation of the erythrocyte sedimentation rate was observed in 131 patients (23.1%). Treatment included drugs, interventional therapy, autologous blood vessel transplant, artificial blood vessel transplant, and aortic valve replacement. During a mean followup of 5.0 ± 0.2 years, 32 patients died, including 1 patient who died suddenly during coronary angiography. HTN, major complications, and a progressive disease course were significant prognostic markers. Conclusion. HTN, rather than fever, is the leading reason for patients with Takayasu arteritis to see a doctor in China. HTN, major complications, and a progressive disease course are statistically significant predictors of survival. Because of cardiovascular events associated with the disease, early diagnosis and treatment are urgent to improve prognosis.

Effect of spironolactone on patients with resistant hypertension and obstructive sleep apnea

ABSTRACT Objective: To examine whether spironolactone could reduce the severity of obstructive sleep apnea (OSA) and lower blood pressure in patients with resistant hypertension. Methods: This was a blank-controlled, single-center study. Patients with resistant hypertension and moderate-to-severe OSA (apnea–hypopnea index >15 events/h) were enrolled and randomly assigned to the therapy or control group. Patients in the therapy group were administered spironolactone 20 mg once daily (up to 40 mg once daily for 4 weeks, if required) in addition to original antihypertensive medication. Follow-up was 12 weeks. Results: Thirty patients were enrolled (n = 15 per group). After 12 weeks of follow-up, apnea–hypopnea index (21.8 ± 15.7 vs. 1.8 ± 12.8, p < 0.05), hypopnea index (9.8 ± 11.1 vs. −2.7 ± 16.8, p < 0.05), oxygen desaturation index (20.8 ± 15.0 vs. 0.3 ± 16.1, p < 0.05), clinical blood pressure, ambulatory blood pressure, and plasma aldosterone level (9.8 ± 6.3 vs. 2.9 ± 6.7, p < 0.05) were reduced significantly in the therapy group compared with the control group. No side effects were reported. Conclusions: Spironolactone reduced the severity of OSA and reduced blood pressure in resistant hypertension patients with moderate-to-severe OSA. These findings may assist in the treatment of OSA in patients with resistant hypertension.

Coronary artery involvement in takayasu arteritis in 45 Chinese patients.

Objective. We investigated the clinical characteristics, potential difficulties in diagnosis, and therapy for coronary artery involvement in patients with Takayasu arteritis (TA). Methods. Of 587 consecutive patients hospitalized with TA from 1998 to 2011, those found to have > 50% reduction of diameter of coronary artery by angiography were recruited. We defined the first finding of coronary involvement as baseline. The clinical features, laboratory data, coronary angiographic findings, treatment, and followup outcomes were summarized retrospectively. Results. A total of 45 (7.7%, 45/587) patients with coronary involvement were identified, including 40 with typical angina, and 15 with myocardial infarction. Some had complications such as peripheral vascular murmur, pulseless disease, and hypertension. The average age at onset of cardiac symptoms was 40.3 ± 12.8 years (range 15–64) and 36 were female. At admission, erythrocyte sedimentation rates were elevated in 27 patients (60%) and C-reactive protein levels in 23 (51.1%). The ostia (37.4%) and proximal segments (33.3%) of coronary artery were most frequently involved. The treatment was stent implantation in 10 patients and coronary artery bypass grafting in 13. One female patient suffered sudden death during the angiography. During a mean followup of 5.8 ± 4.5 years, 8 patients died. Conclusion. Coronary artery involvement in TA that leads to cardiovascular events, especially to cardiovascular death, is not rare. Early diagnosis and therapy should be emphasized.

Selective stent placement versus balloon angioplasty for renovascular hypertension caused by Takayasu arteritis: Two-year results

OBJECTIVES We aimed to investigate the long-term clinical outcomes of selective stenting versus percutaneous balloon angioplasty (PTA) in hypertensive patients with renal artery stenosis caused by Takayasu arteritis (RASTA). METHODS We retrospectively analyzed the data of consecutive 152 RASTA patients from Fuwai Hospital between 2005 and 2012. All target lesions of renal arteries were firstly treated by plain PTA. After angioplasty, if flow-limited dissection and/or residual stenosis >50% of diameter on angiogram existed, a selective stenting was then followed to further morphological improvement. RESULTS The baseline characteristics between PTA (n=93) and stenting groups (n=59) were indistinguishable. At two-year follow-up, the rates of normalized, improved, and unaltered hypertension were 27.4%, 63.4% and 12.3% in PTA group (n=93) versus 22.4%, 62.1% and 15.5% respectively in stenting group (p=0.79). Primary patency rate was 90.1% in renal arteries (125 lesions) treated with PTA versus 75.6% in renal arteries (64 lesions) treated with stent placement (p=0.008). Female, active stage of the disease requiring glucocorticoid and/or immunosuppressant agents, residual stenosis rate and stenting were significantly associated with the restenosis. In patients with restenosis, renal artery occlusion occurred more in stenting group (8/15), compared with that in PTA group (1/12) (p=0.019). The stenting group underwent more reintervention procedures than PTA group (13/63 versus 8/125, p=0.003). CONCLUSIONS If PTA alone failed in treating RASTA, selective stenting resulted in similarly effective blood pressure reduction. Stenting also resulted in lower 2-year primary patency rate, higher occlusion rate and higher reintervention rate than those who did not need stenting.

Stenting for left subclavian artery stenosis in patients scheduled for left internal mammary artery-coronary artery bypass grafting.

To evaluate the early and long‐term outcomes of stent placement for left subclavian artery stenosis (LSAS) in patients scheduled for left internal mammary artery‐coronary artery bypass grafting (LIMA‐CABG).

First-in-man report of a novel dedicated radiofrequency catheter for renal denervation via the transulnar approach.

Renal denervation (RDN) has been shown to be safe and efficacious in reducing blood pressure in patients with resistant hypertension. In the present study, we describe a first-in-man report of the Iberis renal denervation device in a patient who underwent two RDN procedures: one via the femoral artery and one via the transulnar approach. RDN was performed in the patients right renal artery using an Iberis catheter via the transulnar approach, as the transfemoral or transradial arteries could not be approached due to their anatomic constraints. In summary, RDN via the transulnar approach is feasible and represents a technical alternative solution in certain patients.

Aortic aneurysm in Takayasu arteritis

Background: Aortic aneurysm (AA) is a severe complication of Takayasu arteritis (TA). This study aimed to evaluate the prevalence, clinical and imaging features, management and long‐term outcomes of AA in patients with TA. Materials and Methods: A retrospective study was performed of TA patients with AA admitted to Fuwai Hospital from 1996‐2015. Baseline clinical data and follow‐up data of TA patients with AA were collected and analyzed. Results: Thirty‐nine (4.2%) of 934 patients with TA were identified with AA that was related to vasculitis. The mean age at disease onset was 31 ± 10 years, with a female‐to‐male ratio of 1.79:1. The ascending aorta was the most common site of the aneurysmal lesion (18, 33.3%), and the most frequent manifestations associated with AA were chest tightness (12, 30.8%) and shortness of breath (12, 30.8%), which were usually concomitant with aortic valve insufficiency. Involvement of multiple sites in AA was found in 8 patients (20.5%), and multiple AAs were found in 5 patients (12.8%). No significant difference was observed in clinical and imaging findings between sexes. Of 25 patients (64.1%) with a median 72‐month follow‐up, 1 patient suffered from heart failure owing to perivalvular leakage, and 1 patient died, possibly related to severe complications of the operation. Conclusions: The prevalence of AA is relatively low in Chinese patients with TA. AA seems to develop more frequently in male patients with TA. Management should consider location and size of AA, complexity of vessel lesions and disease status. Long‐term follow‐up is indispensable.

Clinical Features and Outcomes of Takayasu Arteritis with Neurological Symptoms in China: A Retrospective Study

Objective. To describe the clinical features and longterm outcomes of patients with Takayasu arteritis (TA) in China who experienced neurological symptoms. Methods. A retrospective study was undertaken of patients with TA who attended a single study center from 2002 to 2013, who also exhibited neurological symptoms (n = 274). Clinical and imaging features were analyzed, as well as longterm outcomes. Results. The mean age at disease onset was 28.2 ± 11.2 years, with a female-to-male ratio of 4.3:1. The most common neurological manifestation was dizziness (214, 78.1%), the most frequent type of TA was type III (112, 40.9%), and the most common affected artery was the left subclavian (147, 53.6%). Involvement of 3 or 4 branches of the aortic arch was observed in 28% of patients. Among 30 patients experiencing a stroke (10.9%), steno-occlusive lesions of the subclavian artery and common carotid artery were frequently observed in patients with ischemic stroke, while steno-occlusive lesions of the descending aorta, abdominal aorta, and/or renal arteries were more frequently observed with hemorrhagic stroke. Heart failure was the most common cardiovascular event in those who died (n = 6) and in surviving cohorts. Conclusion. Neurological features in patients with TA were variable, and correlated with the number of arteries and the site of artery involvement. Resistant hypertension was one of the most important risk factors for hemorrhagic stroke in patients with TA.

Percutaneous transluminal angioplasty for symptomatic pulmonary stenosis in Takayasu arteritis.

Objective. The aim of this study was to evaluate the safety and efficacy of percutaneous transluminal angioplasty (PTA) for symptomatic pulmonary stenosis in Takayasu arteritis (TA). Methods. From January 2009 to December 2012, clinical data of 14 patients [mean age 33.9 ± 9.3 yrs; 11 patients female (78.6%)] with symptomatic pulmonary stenosis in TA underwent PTA and were analyzed prospectively. Results. PTA was successfully performed in 22 lesions of 14 patients. Among those lesions, 18 were treated by PTA alone while the others were treated with stent implantation. Three patients (21.4%) had reperfusion pulmonary injury; 2 patients recovered completely while the other died of respiratory failure 3 days after the procedure. Mean pulmonary arterial pressure (PAP) decreased from 53.4 ± 15.8 mmHg to 38.4 ± 12.7 mmHg immediately after intervention (p < 0.001). After an average of 29 months of followup, the New York Heart Association functional class and 6-min walking distances improved while mean PAP measured by echocardiography decreased significantly (compared with baseline, all p < 0.01). One patient died of severe pulmonary infection and cardiac shock at 28 months after the procedure. Conclusion. The study showed that PTA improved subjective symptoms and objective variables of the patients with symptomatic pulmonary stenosis in TA, with an acceptable mortality. PTA may be a promising therapeutic strategy for symptomatic pulmonary stenosis in TA.

Aortic Dissection in Takayasu Arteritis

Background: Aortic dissection (AD) is a rare complication of Takayasu arteritis (TA). The clinical presentation and long‐term management outcomes of AD in patients with TA have not been well described. Materials and Methods: We conducted a retrospective study of patients with TA along with AD admitted to Fuwai Hospital between January 1985 and March 2016. Clinical data and follow‐up data were collected and analyzed. Results: Of the 1,154 patients with TA, we identified 10 patients (0.87%) with AD, which was likely to be associated with vasculitis. All patients were females with a median age at TA onset of 26.5 years (range: 18.3‐33.3 years), had type III TA and had a history of hypertension, which was much more common than that in previously reported cases. Stanford type B or DeBakey category III was the dominant anatomic classification of AD. Four patients developed AD after the diagnosis of TA, and 6 developed AD near the time of TA diagnosis. Nine patients underwent conservative treatment, whereas 1 patient underwent endovascular repair due to extensive dissection. At a median 70.5‐month follow‐up (range: 31.5‐138.5), we found that 7 patients had no AD progression, 1 patient had progressed without symptoms, 1 patient was lost and 1 patient died. Conclusions: Patients with TA along with long‐standing and poorly controlled hypertension are liable to develop AD. Those with extensive AD in TA should be carefully treated and intensively followed up.