Re is a
Po uguesa
de
Ca diologia
43
(2024)
105---106
www. e po ca diol.o g
Re is a
Po uguesa
de
Ca diologia
Po uguese
Jou nal
o
Ca diology
EDITORIAL
COMMENT
Echoca diog aphic
sc eening
o
al ula
hea
disease
in
g anuloma osis
wi h
polyangii is:
Do
we
need
i ?
Ras eio
ecoca diog áfico
de
al ulopa ia
na
g anuloma ose
com
poliangi e:
p ecisamos
dele?
Ca a ina
de
Sousaa,b,c
aDepa amen o
Co ac¸ão
e
Vasos,
Cen o
Hospi ala
Uni e si á io
Lisboa
No e,
Lisboa,
Po ugal
bCen o
Ca dio ascula
Uni e sidade
de
Lisboa
CCUL-RISE,
Faculdade
de
Medicina
Uni e sidade
de
Lisboa,
Lisboa,
Po ugal
cLusíadas
Knowledge
Cen e ,
Lisboa,
Po ugal
A ailable
online
23
Decembe
2023
Sys emic
asculi ides
a e
a e
au oimmune-media ed
dis-
o de s
a ec ing
a ious
o gans.
Thei
clinical
p esen a ion
is
usually
he e ogeneous,
wi h
a
long
and
di ficul
pe iod
un il
a
diagnosis
is
finally
es ablished.
They
a e
classified
acco ding
o
he
ype
o
a ec ed
essels,
pa hogenesis,
demog aphics
and
clinical
cha ac e is ics.1G anuloma osis
wi h
polyangii is
(GPA),
o me ly
Wegene ’s
g anuloma o-
sis,
is
included
in
he
an ineu ophil
cy oplasmic
an ibody
(ANCA)-associa ed
asculi ides
and
is
cha ac e ized
by
nec o izing
asculi is
o
small
and
medium-sized
essels.
Ea ,
nose
and
h oa ,
lungs,
and
kidneys
a e
mainly
a ec ed,
and
he
disease
occu s
mo e
equen ly
in
pa ien s
in
he
fi h
decade
o
li e.2
Ca dio ascula
mani es a ions
a e
a
common
cause
o
mo bidi y
and
mo ali y
among
pa ien s
wi h
sys emic
asculi is.
Long-s anding
ch onic
inflamma ion
leads
o
sig-
nifican
co ona y,
al ula
and/o
pe ica dial
disease
as
well
as
myoca di is
o
ao ic
in ol emen .
Among
pa ien s
wi h
GPA,
ca dio ascula
in ol emen
is
none heless
a e
(3.3%
in
a
coho
o
517
pa ien s
published
on
behal
o
he
Vas-
E-mail
add ess:
[email p o ec ed]
culi is
Clinical
Resea ch
Conso ium3)
and
he e ogeneous.
Pe ica di is
and
pe ica dial
e usion
a e
he
mos
equen
ca diac
complica ions
seen
in
GPA.4The
fi s
cases
o
ao ic
al ula
we e
desc ibed
in
he
la e
1980s.5Since
hen,
small
e ospec i e
coho
s udies
and
case
epo s
cons i u e
he
only
a ailable
e idence
ha
d i es
clinical
p ac ice.
As
in
all
a e
sys emic
diseases,
bu
especially
in
GPA,
obus
long- e m
p ospec i e
clinical
e idence
on
he
impac
on
he
ca dio ascula
sys em
is
lacking.
In
addi ion,
u he
e idence
is
needed
o
decide
on
he
pe iodici y
o
ca diac
clinical
su eillance.
In
he
cu en
issue
o
he
Jou nal,
Bo owiec
e
al.6
p esen
a
p ospec i e
obse a ional
single-cen e
s udy
on
pa ien s
ini ially
hospi alized
wi h
GPA
and
egula ly
ol-
lowed
in
a
uni e si y
hospi al
in
he
Medical
Uni e si y
o
Wa saw,
Poland,
be ween
Feb ua y
2010
and
No em-
be
2020.
This
is
a
case---con ol
s udy
o
105
pa ien s
analyzed
a
baseline
and
wi h
a
mean
ollow-up
o
up
o
6.2
yea s.
Va iables
analyzed
included
medical
his o y,
physical
examina ion,
labo a o y
s udies
and
echoca dio-
g aphic
examina ion
(mainly
wo-dimensional,
flow
and
issue
Dopple ).
h ps://doi.o g/10.1016/j. epc.2023.12.003
0870-2551/©
2023
Published
by
Else ie
Espa˜
na,
S.L.U.
on
behal
o
Sociedade
Po uguesa
de
Ca diologia.
This
is
an
open
access
a icle
unde
he
CC
BY-NC-ND
license
(h p://c ea i ecommons.o g/licenses/by-nc-nd/4.0/).
C.
de
Sousa
The
included
pa ien s
we e
mos ly
emale
(64%)
and
in
he
fi h
decade
o
li e.
The e
was
a
high
p e alence
o
ca -
dio ascula
isk
ac o s
in
his
popula ion,
wi h
hype ension
and
dyslipidemia
in
66%
and
70%
o
he
s udy
popula ion,
espec i ely.
Mos
pa ien s
we e
on
egula
glucoco icoids
(84%).
The
mos
equen
finding
a
baseline
echoca diog aphy
was
ao ic
egu gi a ion
(43%);
his
was
he
only
al ula
dys unc ion
ha
inc eased
significan ly
du ing
ollow-up,
o
51%
o
he
GPA
g oup.
O
hese
pa ien s,
only
wo
unde wen
ca diac
al e
su ge y.
O he
less
equen
ca diac
findings
we e
ao ic
s enosis
and
mi al
o
icuspid
egu gi a ion,
he
a es
o
which
we e
s able
in
ollow-up.
Ao ic
egu gi a ion
was
also
he
dominan
al ula
find-
ing
in
an
obse a ional
s udy
by
he
same
clinical
g oup,7
in
which
88
pa ien s
wi h
GPA
we e
compa ed
wi h
a
con-
ol
g oup
o
40
age-
and
gende -ma ched
pa ien s
(28%
s.
7.5%;
p=0.03).
Vege a ions,
leafle
hickening,
al ula
pe -
o a ion
and
endoca dial
masses
a e
he
main
mechanisms
in
hea
al e
lesions8desc ibed
in
ANCA-associa ed
sys emic
asculi is,
pa icula ly
GPA.
In
his
long- e m
p ospec i e
s udy6 he
au ho s
did
no
add ess
he
se e i y
o
ao ic
egu gi a ion
o
i s
p og es-
sion
in
non-significan
cases
a
baseline,
which
cons i u es
a
subs an ial
limi a ion
o
comp ehending
he
ull
impac
o
GPA
in
ao ic
al e
disease.
Addi ionally,
he
au ho s
iden ified
D-dime
le els
as
he
only
p edic o
o
ao ic
egu gi a ion
p og ession
in
his
g oup
o
pa ien s.
The
associa ion
o
ele a ed
D-dime s
wi h
inflamma ion
and
disease
ac i i y
may
explain
his
finding.
S ill,
pa ien s
wi h
ao ic
al e
disease
we e
olde ,
and
an
inpu
o
he
mul i a ia e
analysis
o
ca dio ascula
isk
p o-
file
would
help
o
u he
unde s and
he
di e ences
ound,9
which
I
belie e
is
an
impo an
limi a ion
o
he
p esen
analysis.
Finally,
only
ou
(3.8%)
o
he
included
pa ien s
equi ed
ao ic
al e
su ge y
du ing
ollow-up.
Compa ed
o
he
pe cen age
o
cases
o
symp oma ic
and
significan
hea
al e
disease
iden ified
in
he
sys ema ic
e iew
pub-
lished
in
2011,8i
migh
be
a gued
ha
he
long- e m
cou se
may
a e
all
be
less
malignan
han
p e iously
hough .
In
his
s udy,
a
small
s ep
was
defini ely
aken
o
u -
he
unde s and
he
long- e m
impac
o
his
a e
sys emic
asculi is
on
he
ca dio ascula
sys em,
specifically
in
cases
o
al e
in ol emen .
Su eillance
is
manda o y,
bu
he
cu en
e idence
aises
se e al
ques ions
ha
equi e
long-
e m
p ospec i e
s udies
wi h
he
in ol emen
o
mul iple
high- olume
cen e s
o
add ess
hese
issues
and
s eng hen
he
e idence
ha
ul ima ely
guides
us
in
clinical
p ac ice.
Funding
No
ex e nal
o
in e nal
unding
was
p o ided.
Conflic s
o
in e es
The
au ho
has
no
conflic s
o
in e es
o
decla e.
Re e ences
1.
Tani
C,
Bellando
Randone
S,
Guiducci
S,
e
al.
Sys emic
scle osis:
a
c i ical
diges
o
he
ecen
li e a u e.
Clin
Exp
Rheuma ol.
2013;31
(2
Suppl
76):172---9.
2.
Pagnoux
C.
G anuloma osis
wi h
polyangii is.
In:
An i-Neu ophil
Cy oplasmic
An ibody
(ANCA)
Associa ed
Vasculi is.
Sinico
RA,
Guille in
L
(eds).
Cham:
Sp inge ;
2020;
p.
97---129.
3.
McGeoch
L,
Ca e e
S,
Cu hbe son
D,
e
al.
Ca diac
in ol emen
in
g anuloma osis
wi h
polyangii is.
J
Rheuma ol.
2015;42:1209---12.
4.
Ahmed
T,
Me edi h
D,
Klein
AL.
G anuloma osis
wi h
polyangi-
i is
(Wegene ’s
g anuloma osis)
complica ed
by
pe ica di is:
ou
expe ience
o
wo
cases
and
compa a i e
e iew
o
li e a u e.
Case.
2021;5:126---36.
5.
G an
SCD,
Le y
RD,
Venning
MC,
e
al.
Wegene ’s
g anuloma osis
and
he
hea .
B
Hea
J.
1994;71:82---6.
6.
Bo owiec
A,
Rosinska
M,
Kowalik
I,
e
al.
Ca diac
al ula
in ol emen
in
g anuloma osis
wi h
polyangii is
in
long- e m
obse a ion.
Re
Po
Ca diol.
2024;43.
7.
Al-Habbaa
A,
Rawla
P,
Mo a
ME,
e
al.
Val ula
in ol emen
in
g anuloma osis
wi h
polyangii is:
case
epo
and
sys ema ic
e iew
o
li e a u e.
Echoca diog aphy.
2018;35:1456---63.
8.
Lacos e
C,
Mansencal
N,
Ben
M’Rad
M,
e
al.
Val ula
in ol e-
men
in
ANCA-associa ed
sys emic
asculi is:
a
case
epo
and
li e a u e
e iew.
BMC
Musculoskele
Diso d.
2011;12:50.
9.
S ewa
BF,
Sisco ick
D,
Lind
BK,
e
al.
Clinical
ac o s
asso-
cia ed
wi h
calcific
ao ic
al e
disease.
J
Am
Coll
Ca diol.
1997;29:630---4.
106