title: Cardiac involvement in Wegener's granulomatosis resistant to induction therapy.
abstract: OBJECTIVE
  The aim of the study was to assess cardiac involvement in patients with Wegener's granulomatosis (WG), who failed to achieve remission following >6 months induction therapy for life or organ threatening disease.
  
  
  METHODS
  Eleven WG patients (eight males, mean age 47 ± 13 years), who failed to achieve remission despite >6 months induction therapy, underwent transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR).
  
  
  RESULTS
  Cardiac involvement was present in 9 (82%) patients. Regional wall motion abnormalities were found in two individuals, but none had left ventricular (LV) ejection fraction <50%. Nine patients had late gadolinium enhancement (LGE) lesions involving LV myocardium and right ventricle free wall was involved in four patients. LGE lesions were found in subepicardial, midwall and subendocardial LV myocardial layers. CMR revealed myocarditis in six patients. Patients with myocarditis had a higher number of LV segments with LGE (5.2 ± 3.4 vs 1.0 ± 1.2, p = 0.03) and more frequent diastolic dysfunction by TTE (5 vs 0, p = 0.02) than those without. Pericardial effusion was observed in five patients, while localized pericardial thickening in six patients.
  
  
  CONCLUSIONS
  In WG resistant to >6 months induction therapy cardiac involvement is frequent and is characterized by foci of LGE lesions and signs of myocardial inflammatory process.
authors.affiliation: Center for Diagnosis, Prevention and Telemedicine, John Paul II Hospital, ul. Prądnicka 80, 31-202 Kraków, Poland. miszalt@mp.pl
authors.forename: Tomasz
authors.initials: T
authors.lastname: Miszalski-Jamka
authors.forename: Wojciech
authors.initials: W
authors.lastname: Szczeklik
authors.forename: Barbara
authors.initials: B
authors.lastname: Sokołowska
authors.forename: Karol
authors.initials: K
authors.lastname: Miszalski-Jamka
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Karwat
authors.forename: Gabriel
authors.initials: G
authors.lastname: Grządziel
authors.forename: Wojciech
authors.initials: W
authors.lastname: Mazur
authors.forename: Dean J
authors.initials: DJ
authors.lastname: Kereiakes
authors.forename: Jacek
authors.initials: J
authors.lastname: Musiał
mesh_terms: D000328:Adult; D003952:Diagnostic Imaging / Q000379:methods; D004452:Echocardiography / Q000379:methods*; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000175:diagnosis*; D006321:Heart / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis* / Q000473:pathology; D012074:Remission Induction