Background Polymyalgia rheumatica (PMR) is an inflammatory disorder of the elderly, characterized by pain and stiffness in the shoulder and pelvic girdles. It can be isolated or associated with giant cell arteritis (GCA). Similar to other inflammatory rheumatic disorders, PMR is associated with an increased cardiovascular risk, which may result in aortic aneurysms and dissections.
Objectives to investigate the relationship between inflammatory involvement of the ascending aorta and its possible dilatation.
Methods 24 PMR patients (19 females), of whom 4 had also giant cell arteritis, underwent standardized history and clinical examination, including cardiovascular risk factors (CRFs), and transthoracic echocardiography. 20/24 patients underwent also simultaneous FDG-Positron Emission/Computed Tomography (PET/CT). Patients were compared with 24 controls, without inflammatory conditions, matched for age, sex and CRFs (family history of early cardiovascular events, hypertension, dyslipidemia, diabetes mellitus, smoking, alcohol, obesity and a sedentary lifestyle). The echocardiographic parameters were evaluated according to the American Society of Echocardiography recommendations. FDG uptake in joint and vascular regions was semi-quantitatively scored relative to liver uptake as 0=no uptake present, 1=lower than liver uptake, 2=similar to liver uptake, 3=higher than liver uptake. All the values were further subdivided into “positive” (scores 2 and 3) and “negative” (scores 0 and 1).
Results patients and controls did not differ for age, gender, and cardiovascular risk factors. Ten patients (50%) showed vasculitis of the thoracic aorta at PET/CT scan. Echocardiographic results are summarized in table 1. Aortic regurgitation was significantly more frequent and the mean regurgitation grade of the aortic valve was significantly greater in patients than in controls. Patients with vasculitis tended to have more regurgitation (p=0.07). Left atrium diameter, left ventricular end-diastolic diameter and inter-ventricular septum thickness were significantly higher in controls than in PMR patients (p=0.005, p=0.014, and p=0.0036, respectively). Within the PMR group, no correlation was found between echocardiographic changes and demographic data, PMR variables, and type of treatment. TABLE 1. Echocardiographic findings of the study population. AAO: abdominal aorta; AsAO: ascending aorta; AOArch: Aortic Arch; LA: left atrium; PAPS: pulmonary artery systolic pressure; LVEDD: left ventricular end-diastolic dimension; LVESD: left ventricular end-systolic dimension; IVST: interventricular septum thickness; PWD: posterior wall thickness; LVEF: left ventricular ejection fraction.
Conclusions PMR patients showed more frequent and more severe aortic valve regurgitation than matched controls. Aortic regurgitation could be due to an initial inflammatory annular dilatation, because no significant deterioration of the valve leaflets was observed. Controls showed increased heart volumes, a fact that could be ascribed to their being referred to the cardiologist. In conclusion, our results suggest that PMR patients may show early signs of aortic dilatation at the annular level.
Disclosure of Interest None declared
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