Artikel
Aortic aneurysm in Giant Cell Arteritis – the value of D-Dimer
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Autoren
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Franz Hafner
- Medizinische Universität Graz Universitätsklinik für Innere Medizin, Klinische Abteilung für Angiologie, Graz, Österreich
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Elke Haas
- Medizinische Universität Graz Universitätsklinik für Innere Medizin, Klinische Abteilung für Angiologie, Graz, Österreich
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Gerald Hackl
- Medizinische Universität Graz Universitätsklinik für Innere Medizin, Klinische Abteilung für Angiologie, Graz, Österreich
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Thomas Gary
- Medizinische Universität Graz Universitätsklinik für Innere Medizin, Klinische Abteilung für Angiologie, Graz, Österreich
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Klara Belaj
- Medizinische Universität Graz Universitätsklinik für Innere Medizin, Klinische Abteilung für Angiologie, Graz, Österreich
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Johannes Fessler
- Medizinische Universität Graz Universitätsklinik für Innere Medizin, Klinische Abteilung für Rheumatologie, Graz, Österreich
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Peter Rief
- Medizinische Universität Graz Universitätsklinik für Innere Medizin, Klinische Abteilung für Angiologie, Graz, Österreich
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Rene Thonhofer
- LKH Mürzzuschlag, Rheumatologie, Mürzzuschlag, Österreich
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Dieter Szolar
- Diagnostikum Graz Südwest, Graz, Österreich
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Marianne Brodmann
- Medizinische Universität Graz Universitätsklinik für Innere Medizin, Klinische Abteilung für Angiologie, Graz, Österreich
| Veröffentlicht: | 12. September 2014 |
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Gliederung
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Background: Giant cell arteritis (GCA) is an autoimmune disorder affecting medium- and large sized arteries. The most common symptoms are related to ischemic cranial involvement. Nevertheless, asymptomatic aortic involvement may cause aneurysm and dissections. D-Dimer was discussed as a potential biomarker in the evaluation of aortic aneurysms and dissections. The aim of the study was to evaluate D-Dimer and aortic diameters measured by CT-angiography (CTA) in a cohort of GCA patients.
Methods: All patients with diagnosed GCA at least two years prior to enrolment underwent CTA of the thoracal and abdominal aorta. D-Dimer was assessed in all patients prior to the CT-scans.
Results: 119 Patients with GCA (90 female) were included. 103 patients (80 female) were eligible for statistical analysis. Mean age of GCA patients was 74.0 ±7.9 years, included 54.8 ±33.8 months after GCA diagnosis. Mean thoracic aortic diameters [values/m² BSA] were 34.41 ±4.69mm [19.76 ±3.16mm/m²], 28.08 ±3.67mm [16.09 ± 2.40mm/m² BSA] and 25.61 ±3.37mm [14.68 ±2.33mm/m² BSA] at the ascending aorta (AAT), the aortic arch (ART) and the descending aorta (DAT) respectively. Aortic ectasias, defined as aortic diameter above the 90% quartile of age adjusted reference values were present in 17 GCA patients (16.5%) at the AAT and in 16 patients (15.5%) at the DAT. Abdominal aortic ectasias were present in 31 patients (35.9%). D-Dimer was above the cut-off value of 0.5mg/l in 62 GCA patients (60.2%). Elevated D-Dimer was present in 11 (64.7%) patients with ectasia of the AAT and in 9 (56.3%) patients with ectasia of the DAT (p 0.790 and 0.785 repsectively). Pulmonary arterial embolism was excluded in all patients by CT-angiography.
Conclusion: Recent data suggest that the risk developing aortic aneurysms after GCA diagnosis might be overestimated. D-Dimer failed to identify patients at risk for aortic dilatation secondary to giant cell arteritis. Reference values for D-Dimer are to be discussed in such a cohort of elderly patients suffering from a chronic inflammatory disease.
