AAV Patients Exhibit Heart Abnormalities Near Time of Diagnosis, Study Shows

Patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) exhibit abnormalities in heart function near the time of diagnosis, a new study shows. Importantly, each AAV subtype had its own pattern of heart abnormalities.

The study, “Echocardiographic features in patients with ANCA-associated vasculitis within 3 months before and after diagnosis,” was published in Clinical Rheumatology.

AAV is defined by the inflammation and destruction of small blood vessels. The disease can be classified into three subtypes: microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA), and eosinophilic granulomatosis with polyangiitis (EGPA).

AAV is associated with inflammation in almost all systemic organs, including the heart. But the frequency of cardiovascular manifestations in patients with AAV depends on the variants. It most frequently appears in ANCA-negative EGPA patients (22-49%); followed by MPA patients (10-20%); GPA patients (5-15%); and ANCA-positive EGPA patients (0-12%).

Echocardiographic features refer to the features of the heart as it relates to function and traits. There are several studies that detail the echocardiographic features in each AAV subtype. However, there are few studies that report echocardiographic results in all variants of AAV and that compare the variables between them.

So, researchers in Korea set out to investigate all-inclusive echocardiographic features in patients with MPA, GPA, and EGPA within three months before and after diagnosis. The time frame was picked to include only the time before the immunosuppressive treatments administered for AAV were in full effect, likely reflecting actual cardiac function.

Researchers reviewed medical records of 89 AAV patients and 35 healthy controls.

Patients with AAV exhibited reduced mean left ventricle ejection fraction at 64% compared to 69.1% in controls. This indicates that a lower amount of blood is pumped out of the heart with each heartbeat in AAV patients.

Further, AAV patients exhibited a higher mean E/E′ ratio, which indicates higher pressure in the left atrium of the heart. The right ventricle systolic pressure was also higher in patients with AAV than the controls.

When examining each subtype separately, patients with MPA exhibited systolic and diastolic dysfunctions and pulmonary arterial hypertension (PAH) more frequently than the healthy controls.

Patients with GPA only exhibited diastolic dysfunction. EGPA patients, on the other hand, had systolic dysfunction and PAH compared to controls.

A comparison of the subtypes showed no significant differences in echocardiographic features.

Therefore, “AAV patients might have reduced systolic function and advanced diastolic dysfunctions and pulmonary arterial hypertension near the time of diagnosis, compared with controls, but no meaningful differences appeared among AAV variants,” the researchers concluded.