Canadian Journal of Cardiology 30 (2014) 464.e13e464.e14 www.onlinecjc.ca
Images in Cardiology
Optical Coherence Tomography Imaging of Takayasu Coronary Arteritis Myriam Amsallem, MD, Patrick Henry, MD, PhD, and Stephane Manzo Silberman, MD Department of Cardiology, Lariboisière Hospital, AP-HP e Paris Diderot University, Paris, France
A 33-year-old Caribbean woman, with a medical history of Crohn’s disease, was admitted for acute heart failure (New York Heart Association class IV). Echocardiography showed a dilated left ventricle, low ejection fraction (30%), and a severe aortic regurgitation secondary to dilation of the aortic root. Because of an increase in troponin level (peak, 2.1 mg/L; normal, < 0.05 mg/L), coronary angiography was performed, showing a severe stenosis of the medium portion of the left anterior descending artery, and chronic occlusions of the second obtuse marginal and the second diagonal. Frequency domain optical coherence tomography (OCT) of the left anterior descending artery lesion demonstrated multiple homogenous concentric stenoses, with high tissue backscatter and regular lumen shape. There was neither dissection nor lipid plaque (Fig. 1). Angioplasty was performed using an everolimus-eluting stent (2.75 mm 33 mm). In the context of autoimmunity, biological inflammatory syndrome (C-reactive protein at 110 mg/mL, erythrocyte sedimentation rate at 65 mm per hour) and aortic regurgitation in a young woman, Takayasu arteritis was evoked, then confirmed using angio-computed tomography scan findings (Supplemental Fig. S1). Corticosteroids (prednisone 1 mg/kg/d) were given. The clinical course was favourable with improvement of dyspnea (New York Heart Association class II) and left ventricular ejection fraction (50%) at 2 months after discharge.
Used primarily to rule out coronary dissection, OCT showed the very rare aspect of stepped concentric stenosis without atheromatous plaque, evoking the diagnosis of Takayasu arteritis, which is a rare large vessel vasculitis affecting the aorta and its principal branches, mostly in young women. Histopathologic analysis showed a panarteritis, leading to wall thickening of all 3 layers and then to segmental stenosis, occlusion, and/or aneurysm formation.1 Coronary artery involvement, which is rare but of bad prognosis, has been previously assessed using computed tomography scans, finding ostial (28%) and nonostial (23.4%) coronary arterial stenosis and 8.1% of coronary aneurysms.2 To our knowledge, this is the first OCT description of coronary Takayasu arteritis.
Received for publication November 17, 2013. Accepted December 21, 2013.
Supplementary Material To access the supplementary material accompanying this article, visit the online version of the Canadian Journal of Cardiology at www.onlinecjc.ca and at http://dx.doi.org/10. 1016/j.cjca.2013.12.019.
Corresponding author: Dr Myriam Amsallem, Department of Cardiology, Lariboisière Hospita, Assistance Publique, Hôpitaux de Paris, 2 rue Ambroise Pare, 75010 Paris, France. Tel.: þ33-6-85-89-03-44; fax: þ33-1-49-95-84-39. E-mail: [email protected] See page 464.e13 for disclosure information.
Disclosures The authors have no conflicts of interest to disclose. References 1. Endo M, Tomizawa Y, Nishida H, et al. Angiographic findings and surgical treatments of coronary artery involvement in takayasu arteritis. J Thorac Cardiovasc Surg 2003;125:570-7. 2. Kang EJ, Kim SM, Choe YH, et al. Takayasu arteritis: assessment of coronary arterial abnormalities with 128-section dual source CT angiography of the coronary arteries and aorta. Radiology 2014;270:74-81.
0828-282X/$ - see front matter Ó 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.cjca.2013.12.019
464.e14
Canadian Journal of Cardiology Volume 30 2014
Figure 1. Coronary angiogram (cranial right view) showing a long severe stenosis (arrow) of the mid portion of the left anterior descending artery and FD-OCT showing a homogenous concentric stenosis, with high tissue backscatter, without any major lipid plaque (C7 Dragonfly FD-OCT catheter, St Jude Medical); longitudinal axis view (centre panel); cross-sectional images (AeE). Asterisks indicate guide-wire artifact. FD, frequency domain; OCT, optical coherence tomography.
Images in Cardiology
Optical Coherence Tomography Imaging of Takayasu Coronary Arteritis Myriam Amsallem, MD, Patrick Henry, MD, PhD, and Stephane Manzo Silberman, MD Department of Cardiology, Lariboisière Hospital, AP-HP e Paris Diderot University, Paris, France
A 33-year-old Caribbean woman, with a medical history of Crohn’s disease, was admitted for acute heart failure (New York Heart Association class IV). Echocardiography showed a dilated left ventricle, low ejection fraction (30%), and a severe aortic regurgitation secondary to dilation of the aortic root. Because of an increase in troponin level (peak, 2.1 mg/L; normal, < 0.05 mg/L), coronary angiography was performed, showing a severe stenosis of the medium portion of the left anterior descending artery, and chronic occlusions of the second obtuse marginal and the second diagonal. Frequency domain optical coherence tomography (OCT) of the left anterior descending artery lesion demonstrated multiple homogenous concentric stenoses, with high tissue backscatter and regular lumen shape. There was neither dissection nor lipid plaque (Fig. 1). Angioplasty was performed using an everolimus-eluting stent (2.75 mm 33 mm). In the context of autoimmunity, biological inflammatory syndrome (C-reactive protein at 110 mg/mL, erythrocyte sedimentation rate at 65 mm per hour) and aortic regurgitation in a young woman, Takayasu arteritis was evoked, then confirmed using angio-computed tomography scan findings (Supplemental Fig. S1). Corticosteroids (prednisone 1 mg/kg/d) were given. The clinical course was favourable with improvement of dyspnea (New York Heart Association class II) and left ventricular ejection fraction (50%) at 2 months after discharge.
Used primarily to rule out coronary dissection, OCT showed the very rare aspect of stepped concentric stenosis without atheromatous plaque, evoking the diagnosis of Takayasu arteritis, which is a rare large vessel vasculitis affecting the aorta and its principal branches, mostly in young women. Histopathologic analysis showed a panarteritis, leading to wall thickening of all 3 layers and then to segmental stenosis, occlusion, and/or aneurysm formation.1 Coronary artery involvement, which is rare but of bad prognosis, has been previously assessed using computed tomography scans, finding ostial (28%) and nonostial (23.4%) coronary arterial stenosis and 8.1% of coronary aneurysms.2 To our knowledge, this is the first OCT description of coronary Takayasu arteritis.
Received for publication November 17, 2013. Accepted December 21, 2013.
Supplementary Material To access the supplementary material accompanying this article, visit the online version of the Canadian Journal of Cardiology at www.onlinecjc.ca and at http://dx.doi.org/10. 1016/j.cjca.2013.12.019.
Corresponding author: Dr Myriam Amsallem, Department of Cardiology, Lariboisière Hospita, Assistance Publique, Hôpitaux de Paris, 2 rue Ambroise Pare, 75010 Paris, France. Tel.: þ33-6-85-89-03-44; fax: þ33-1-49-95-84-39. E-mail: [email protected] See page 464.e13 for disclosure information.
Disclosures The authors have no conflicts of interest to disclose. References 1. Endo M, Tomizawa Y, Nishida H, et al. Angiographic findings and surgical treatments of coronary artery involvement in takayasu arteritis. J Thorac Cardiovasc Surg 2003;125:570-7. 2. Kang EJ, Kim SM, Choe YH, et al. Takayasu arteritis: assessment of coronary arterial abnormalities with 128-section dual source CT angiography of the coronary arteries and aorta. Radiology 2014;270:74-81.
0828-282X/$ - see front matter Ó 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.cjca.2013.12.019
464.e14
Canadian Journal of Cardiology Volume 30 2014
Figure 1. Coronary angiogram (cranial right view) showing a long severe stenosis (arrow) of the mid portion of the left anterior descending artery and FD-OCT showing a homogenous concentric stenosis, with high tissue backscatter, without any major lipid plaque (C7 Dragonfly FD-OCT catheter, St Jude Medical); longitudinal axis view (centre panel); cross-sectional images (AeE). Asterisks indicate guide-wire artifact. FD, frequency domain; OCT, optical coherence tomography.
