ANCA-Associated Vasculitides Valvular Impairment: Multicenter Retrospective Study and Systematic Review of the Literature - Inserm - Institut national de la santé et de la recherche médicale Access content directly
Journal Articles Journal of Rheumatology Year : 2022

ANCA-Associated Vasculitides Valvular Impairment: Multicenter Retrospective Study and Systematic Review of the Literature

Lina Jeantin
Tiphaine Lenfant
Hubert de Boysson
Nicolas Martin Silva
Matthieu Monge
Xavier Puéchal

Abstract

Objective While myocardial impairment is a predictor of poor prognosis in antineutrophil cytoplasm antibody (ANCA)-associated vasculitides (AAV), little is known about valvular involvement. This study aims at describing the clinical presentation, management, and outcome of endocarditis associated with AAV. Methods We conducted a multicenter retrospective study in centers affiliated with the French Vasculitis Study Group. We included patients with granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), or eosinophilic GPA with endocardial impairment. A systematic review was then performed through PubMed, Embase, and Cochrane Library from inception up to September 2020. Results The retrospective cohort included 9 patients (82%) with GPA, 1 (9%) with MPA, and 1 (9%) with unclassified AAV. Clinical presentation included acute valvular insufficiency (n = 7, 64%), cardiac failure (n = 3, 27%), dyspnea (n = 3, 27%), and no symptoms (n = 2, 18%). The aortic valve was the most frequently affected (n = 8/10, 80%), and vegetations were noted in 4 of 10 patients (40%). Six patients (55%) underwent surgical valvular replacement. No death from endocarditis was reported. The systematic review retrieved 42 patients from 40 references: 30 (71%) had GPA, 21 (50%) presented with vegetations, the aortic valve (n = 26, 62%) was the most frequently involved. Valvular replacement was required in 20 cases (48%) and 5 patients (13%) died from the endocarditic impairment. Conclusion Endocarditis is a rare and potentially life-threatening manifestation of AAV. Acute valvular insufficiency may lead to urgent surgery. Implementing transthoracic echocardiography in standard assessment at baseline and follow-up of AAV might reduce the delay to diagnosis and allow earlier immunosuppressive treatment before surgery is needed.
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Dates and versions

inserm-03868121 , version 1 (23-11-2022)

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Lina Jeantin, Tiphaine Lenfant, Pierre Bataille, Hubert de Boysson, Pascal Cathébras, et al.. ANCA-Associated Vasculitides Valvular Impairment: Multicenter Retrospective Study and Systematic Review of the Literature. Journal of Rheumatology, 2022, pp.jrheum.211379. ⟨10.3899/jrheum.211379⟩. ⟨inserm-03868121⟩
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