Heart valve dysfunction is common in people with GPA: Study
For most the problem is mild, but some patients can have severe complications
About half of people with granulomatosis with polyangiitis (GPA) have impairment of a valve in the heart, a study from Poland indicates.
This heart valve dysfunction doesn’t cause notable problems for most patients, but a handful may have more severe complications that can require heart surgery. More research into heart valve involvement in GPA, as well as for more rigorous monitoring of patients’ hearts is needed, said the study’s scientists.
“Systematic cardiac monitoring … can contribute to the early detection and appropriate treatment of [heart valve dysfunction] and should be central to the long-term management of patients with vasculitis,” they wrote in “Cardiac valvular involvement in granulomatosis with polyangiitis in long-term observation,” which was published in Revista Portuguesa de Cardiologia.
When the heart pumps blood out to the body, oxygen-rich blood flows out of the left side of the heart through the aortic valve. Normally, this valve opens when the heart contracts, allowing blood to be pushed out into the blood vessels. As the heart relaxes to fill up with fresh blood, the valve closes to prevent the just-pumped blood from flowing back into the heart.
Heart valve involvement in GPA
In Aortic regurgitation (AR), the valve doesn’t close properly, resulting in some backward flow of blood. There have been reports of AR in people with GPA, but not much prospective research into how common it is, leading scientists here to examine rates of AR among 105 people with GPA who were cared for at a center in Warsaw, Poland. They were followed for six years, on average.
“To the best of our knowledge, this is the first long-term observation to analyze valve involvement in GPA patients,” the researchers noted.
When GPA was diagnosed, 43% of the patients had detectable AR. By the end of follow-up, more than half (52.4%) had AR.
In most cases, the severity of AR was mild. But some patients had moderate and even severe AR, and during the follow-up, the number of patients with moderate to severe AR increased, suggesting heart valve dysfunction can worsen over time.
Two patients received heart valve surgeries during follow-up. Patients with worsening AR throughout follow-up tended to have higher levels of D-dimer, a blood marker of clotting, when they were diagnosed with GPA, suggesting D-dimer might be a useful biomarker of heart health in the condition.
The findings suggest heart valve dysfunction is common in people with GPA and, while it’s usually mild, it can be serious in some cases.
“Routine cardiac examination and echocardiography in patients with GPA should therefore be implemented as early as possible to manage these rare, but potentially fatal cardiac complications,” said the scientists, who also noted the lack of guidelines for managing heart valve problems in GPA and the absence of research. They said more research into heart valve involvement in GPA is needed to verify and expand on this study.