nach oben

Rheumatology International

Erschienen in:

17.02.2016 | Observational Research

Cardiac involvement in primary systemic vasculitis and potential drug therapies to reduce cardiovascular risk

verfasst von: Durga Prasanna Misra, Sajjan N. Shenoy

Erschienen in: Rheumatology International | Ausgabe 1/2017

Einloggen, um Zugang zu erhalten

Abstract

Cardiac involvement is common in primary systemic vasculitides and may be due to direct effect of the disease on the heart or due to therapy. We shall review involvement of the heart in the various forms of primary systemic vasculitis. Among anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV), eosinophilic granulomatosis with polyangiitis most commonly involves the heart. Involvement of the heart confers poorer prognosis in AAV, which is also complicated by increased risk of cardiovascular events. Kawasaki’s disease (KD) is the most common form of medium-vessel vasculitis to affect the heart, with coronary artery aneurysms being the most common manifestation. These predispose patients with KD to develop premature ischemic heart disease. Takayasu’s arteritis is the most common large-vessel vasculitis to involve the heart and can result in aortic incompetence, myocarditis, or coronary heart disease. Involvement of the heart in Behcet’s disease is usually in the form of intracardiac mass lesions, thrombosis, or endomyocardial fibrosis. Drugs used in the treatment of systemic vasculitis influence the risk of developing cardiovascular events. Corticosteroid therapy has been shown to increase the risk of myocardial infarction, whereas methotrexate, azathioprine, mycophenolate mofetil, rituximab, and anti-tumor necrosis alpha agents favorably modulate the risk of cardiovascular events, predominantly by dampening systemic inflammation. Awareness of cardiac involvement in vasculitis and accelerated cardiovascular risk in these patients should help clinicians to maximize the modulation of modifiable risk factors for heart disease in these individuals.

Gasparyan AY, Stavropoulos-Kalinoglou A, Mikhailidis DP et al (2010) The rationale for comparative studies of accelerated atherosclerosis in rheumatic diseases. Curr Vasc Pharmacol 8:437–449PubMedCrossRef

Jennette JC, Falk RJ, Bacon PA et al (2013) 2012 revised international chapel hill consensus conference nomenclature of vasculitides. Arthritis Rheum 65:1–11. doi:10.1002/art.37715 PubMedCrossRef

Gasparyan AY, Ayvazyan L, Blackmore H, Kitas GD (2011) Writing a narrative biomedical review: considerations for authors, peer reviewers, and editors. Rheumatol Int 31:1409–1417. doi:10.1007/s00296-011-1999-3 PubMedCrossRef

Hazebroek MR, Kemna MJ, Schalla S et al (2015) Prevalence and prognostic relevance of cardiac involvement in ANCA-associated vasculitis: Eosinophilic granulomatosis with polyangiitis and granulomatosis with polyangiitis. Int J Cardiol 199:170–179. doi:10.1016/j.ijcard.2015.06.087 PubMedCrossRef

Guillevin L, Pagnoux C, Seror R et al (2011) The Five-Factor Score revisited: assessment of prognoses of systemic necrotizing vasculitides based on the French Vasculitis Study Group (FVSG) cohort. Medicine (Baltimore) 90:19–27. doi:10.1097/MD.0b013e318205a4c6 CrossRef

Wallace ZS, Lu N, Unizony S, Stone JH, Choi HK (2015) Improved survival in granulomatosis with polyangiitis: a general population-based study. Semin Arthritis Rheum. doi:10.1016/j.semarthrit.2015.07.009 PubMed

McGeoch L, Carette S, Cuthbertson D et al (2015) Cardiac involvement in granulomatosis with polyangiitis. J Rheumatol 42:1209–1212. doi:10.3899/jrheum.141513 PubMedPubMedCentralCrossRef

Pierrot-Deseilligny Despujol C, Pouchot J, Pagnoux C, Coste J, Guillevin L (2010) Predictors at diagnosis of a first Wegener’s granulomatosis relapse after obtaining complete remission. Rheumatology (Oxford) 49:2181–2190. doi:10.1093/rheumatology/keq244 CrossRef

Lacoste C, Mansencal N, M Ben M’rad et al (2011) Valvular involvement in ANCA-associated systemic vasculitis: a case report and literature review. BMC Musculoskelet Disord 12:50. doi:10.1186/1471-2474-12-50 PubMedPubMedCentralCrossRef

10.

Singh R, Rosen S (2012) Tumor of the heart in a young woman; a rare manifestation of Wegener granulomatosis. Hum Pathol 43:289–292. doi:10.1016/j.humpath.2011.04.020 PubMedCrossRef

11.

Misra DP, Chowdhury AC, Edavalath S et al (2016) Endocarditis: the great mimic of rheumatic diseases. Trop Doct. doi:10.1177/0049475515624031

12.

Miszalski-Jamka T, Szczeklik W, Nycz K et al (2012) Two-dimensional speckle-tracking echocardiography reveals systolic abnormalities in granulomatosis with polyangiitis (Wegener’s). Echocardiography 29:803–809. doi:10.1111/j.1540-8175.2012.01699.x PubMedCrossRef

13.

Miszalski-Jamka T, Szczeklik W, Sokolowska B et al (2013) Standard and feature tracking magnetic resonance evidence of myocardial involvement in Churg–Strauss syndrome and granulomatosis with polyangiitis (Wegener’s) in patients with normal electrocardiograms and transthoracic echocardiography. Int J Cardiovasc Imaging 29:843–853. doi:10.1007/s10554-012-0158-6 PubMedCrossRef

14.

Miszalski-Jamka T, Szczeklik W, Sokolowska B et al (2011) Cardiac involvement in Wegener’s granulomatosis resistant to induction therapy. Eur Radiol 21:2297–2304. doi:10.1007/s00330-011-2203-6 PubMedPubMedCentralCrossRef

15.

Guillevin L, Durand-Gasselin B, Cevallos R et al (1999) Microscopic polyangiitis: clinical and laboratory findings in eighty-five patients. Arthritis Rheum 42:421–430PubMedCrossRef

16.

Shuai ZW, Lv YF, Zhang MM, Hu ZY (2015) Clinical analysis of patients with myeloperoxidase antineutrophil cytoplasmic antibody-associated vasculitis. Genet Mol Res 14:5296–5303. doi:10.4238/2015.May.18.22 PubMedCrossRef

17.

Mavrogeni S, Manoussakis MN, Karagiorga TC et al (2009) Detection of coronary artery lesions and myocardial necrosis by magnetic resonance in systemic necrotizing vasculitides. Arthritis Care Res (Hoboken) 61:1121–1129. doi:10.1002/art.24695 CrossRef

18.

Gendelman S, Zeft A, Spalding SJ (2013) Childhood-onset eosinophilic granulomatosis with polyangiitis (formerly Churg–Strauss syndrome): a contemporary single-center cohort. J Rheumatol 40:929–935. doi:10.3899/jrheum.120808 PubMedCrossRef

19.

Moosig F, Bremer JP, Hellmich B et al (2013) A vasculitis centre based management strategy leads to improved outcome in eosinophilic granulomatosis and polyangiitis (Churg–Strauss, EGPA): monocentric experiences in 150 patients. Ann Rheum Dis 72:1011–1017. doi:10.1136/annrheumdis-2012-201531 PubMedCrossRef

20.

Dennert RM, Van Paassen P, Schalla S et al (2010) Cardiac involvement in Churg–Strauss syndrome. Arthritis Rheum 62:627–634. doi:10.1002/art.27263 PubMed

21.

Vinit J, Bielefeld P, Muller G et al (2010) Heart involvement in Churg–Strauss syndrome: retrospective study in French Burgundy population in past 10 years. Eur J Intern Med 21:341–346. doi:10.1016/j.ejim.2010.05.004 PubMedCrossRef

22.

McKinney EF, Willcocks LC, Broecker V, Smith KGC (2014) The immunopathology of ANCA-associated vasculitis. Semin Immunopathol 36:461–478. doi:10.1007/s00281-014-0436-6 PubMedPubMedCentralCrossRef

23.

Gioffredi A, Maritati F, Oliva E, Buzio C (2014) Eosinophilic granulomatosis with polyangiitis: an overview. Front Immunol 5:549. doi:10.3389/fimmu.2014.00549 PubMedPubMedCentralCrossRef

24.

Mavrogeni S, Karabela G, Gialafos E et al (2013) Cardiac involvement in ANCA (+) and ANCA (−) Churg–Strauss syndrome evaluated by cardiovascular magnetic resonance. Inflamm Allergy Drug Targets 12:322–327PubMedCrossRef

25.

Marmursztejn J, Guillevin L, Trebossen R et al (2013) Churg–Strauss syndrome cardiac involvement evaluated by cardiac magnetic resonance imaging and positron-emission tomography: a prospective study on 20 patients. Rheumatology (Oxford) 52:642–650. doi:10.1093/rheumatology/kes155 CrossRef

26.

Szczeklik W, Miszalski-Jamka T, Mastalerz L et al (2011) Multimodality assessment of cardiac involvement in Churg–Strauss syndrome patients in clinical remission. Circ J 75:649–655PubMedCrossRef

27.

Marmursztejn J, Cohen P, Duboc D et al (2010) Cardiac magnetic resonance imaging in Churg–Strauss-syndrome. Impact of immunosuppressants on outcome assessed in a prospective study on 8 patients. Clin Exp Rheumatol 28:8–13PubMed

28.

Miszalski-Jamka T, Szczeklik W, Nycz K et al (2012) The mechanics of left ventricular dysfunction in patients with Churg–Strauss syndrome. Echocardiography 29:568–578. doi:10.1111/j.1540-8175.2011.01654.x PubMedCrossRef

29.

Szczeklik W, Sokolowska BM, Mastalerz L et al (2011) QT dispersion in patients with Churg–Strauss syndrome. Kardiol Pol 69:1143–1149PubMed

30.

Groh M, Masciocco G, Kirchner E et al (2014) Heart transplantation in patients with eosinophilic granulomatosis with polyangiitis (Churg–Strauss syndrome). J Heart Lung Transplant 33:842–850. doi:10.1016/j.healun.2014.02.023 PubMedCrossRef

31.

Morgan MD, Turnbull J, Selamet U et al (2009) Increased incidence of cardiovascular events in patients with antineutrophil cytoplasmic antibody-associated vasculitides: a matched-pair cohort study. Arthritis Rheum 60:3493–3500. doi:10.1002/art.24957 PubMedCrossRef

32.

Chironi G, Pagnoux C, Simon A et al (2007) Increased prevalence of subclinical atherosclerosis in patients with small-vessel vasculitis. Heart 93:96–99. doi:10.1136/hrt.2006.088443 PubMedCrossRef

33.

Terrier B, Chironi G, Pagnoux C et al (2014) Factors associated with major cardiovascular events in patients with systemic necrotizing vasculitides: results of a longterm followup study. J Rheumatol 41:723–729. doi:10.3899/jrheum.130882 PubMedCrossRef

34.

Bae YD, Choi HJ, Lee JC et al (2006) Clinical features of polyarteritis nodosa in Korea. J Korean Med Sci 21:591–595PubMedPubMedCentralCrossRef

35.

Schrader ML, Hochman JS, Bulkley BH (1985) The heart in polyarteritis nodosa: a clinicopathologic study. Am Heart J 109:1353–1359PubMedCrossRef

36.

Gunal N, Kara N, Cakar N et al (1997) Cardiac involvement in childhood polyarteritis nodosa. Int J Cardiol 60:257–262PubMedCrossRef

37.

Zoller B, Li X, Sundquist J, Sundquist K (2012) Risk of subsequent coronary heart disease in patients hospitalized for immune-mediated diseases: a nationwide follow-up study from Sweden. PLoS One 7:e33442. doi:10.1371/journal.pone.0033442 PubMedPubMedCentralCrossRef

38.

Bourgarit A, Le Toumelin P, Pagnoux C et al (2005) Deaths occurring during the first year after treatment onset for polyarteritis nodosa, microscopic polyangiitis, and Churg–Strauss syndrome: a retrospective analysis of causes and factors predictive of mortality based on 595 patients. Medicine (Baltimore) 84:323–330CrossRef

39.

Fortin PR, Larson MG, Watters AK et al (1995) Prognostic factors in systemic necrotizing vasculitis of the polyarteritis nodosa group—a review of 45 cases. J Rheumatol 22:78–84PubMed

40.

Guillevin L, Lhote F, Gayraud M et al (1996) Prognostic factors in polyarteritis nodosa and Churg–Strauss syndrome. A prospective study in 342 patients. Medicine (Baltimore) 75:17–28CrossRef

41.

Singh S, Vignesh P, Burgner D (2015) The epidemiology of Kawasaki disease: a global update. Arch Dis Child 100:1084–1088. doi:10.1136/archdischild-2014-307536 PubMedCrossRef

42.

Han BK, Lesser A, Rosenthal K et al (2014) Coronary computed tomographic angiographic findings in patients with Kawasaki disease. Am J Cardiol 114:1676–1681. doi:10.1016/j.amjcard.2014.09.004 PubMedCrossRef

43.

Tacke CE, Kuipers IM, Groenink M, Spijkerboer AM, Kuijpers TW (2011) Cardiac magnetic resonance imaging for noninvasive assessment of cardiovascular disease during the follow-up of patients with Kawasaki disease. Circ Cardiovasc Imaging 4:712–720. doi:10.1161/circimaging.111.965996 PubMedCrossRef

44.

Chaudhuri K, Singh Ahluwalia T, Singh S, Binepal G, Khullar M (2011) Polymorphism in the promoter of the CCL5 gene (CCL5G-403A) in a cohort of North Indian children with Kawasaki disease. A preliminary study. Clin Exp Rheumatol 29:S126–S130PubMed

45.

Caballero-Mora FJ, Alonso-Martin B, Tamariz-Martel-Moreno A, Cano-Fernandez J, Sanchez-Bayle M (2011) Kawasaki disease in 76 patients. Risk factors for coronary artery aneurysms. An Pediatr (Barc) 74:232–238. doi:10.1016/j.anpedi.2010.11.024 CrossRef

46.

Callinan LS, Tabnak F, Holman RC et al (2012) Kawasaki syndrome and factors associated with coronary artery abnormalities in California. Pediatr Infect Dis J 31:894–898. doi:10.1097/INF.0b013e31825c4d7c PubMedCrossRef

47.

Kim JJ, Hong YM, Yun SW et al (2012) Assessment of risk factors for Korean children with Kawasaki disease. Pediatr Cardiol 33:513–520. doi:10.1007/s00246-011-0143-1 PubMedCrossRef

48.

Falcini F, Rigante D, Masi L et al (2013) Fibroblast growth factor 23 (FGF23) gene polymorphism in children with Kawasaki syndrome (KS) and susceptibility to cardiac abnormalities. Ital J Pediatr 39:69. doi:10.1186/1824-7288-39-69 PubMedPubMedCentralCrossRef

49.

Giannouli G, Tzoumaka-Bakoula C, Kopsidas I et al (2013) Epidemiology and risk factors for coronary artery abnormalities in children with complete and incomplete Kawasaki disease during a 10-year period. Pediatr Cardiol 34:1476–1481. doi:10.1007/s00246-013-0673-9 PubMedCrossRef

50.

Ruan Y, Ye B, Zhao X (2013) Clinical characteristics of Kawasaki syndrome and the risk factors for coronary artery lesions in China. Pediatr Infect Dis J 32:e397–e402. doi:10.1097/INF.0b013e31829dd45e PubMedCrossRef

51.

Maric LS, Knezovic I, Papic N et al (2015) Risk factors for coronary artery abnormalities in children with Kawasaki disease: a 10-year experience. Rheumatol Int 35:1053–1058. doi:10.1007/s00296-014-3186-9 PubMedCrossRef

52.

Kuwabara M, Yashiro M, Kotani K et al (2015) Cardiac lesions and initial laboratory data in Kawasaki disease: a nationwide survey in Japan. J Epidemiol 25:189–193. doi:10.2188/jea.JE20140128 PubMedCrossRef

53.

Ye Q, Shao WX, Shang SQ et al (2015) A comprehensive assessment of the value of laboratory indices in diagnosing Kawasaki disease. Arthritis Rheumatol 67:1943–1950. doi:10.1002/art.39112 PubMedCrossRef

54.

Lin YJ, Chang JS, Liu X et al (2015) Genetic variants in PLCB4/PLCB1 as susceptibility loci for coronary artery aneurysm formation in Kawasaki disease in Han Chinese in Taiwan. Sci Rep 5:14762. doi:10.1038/srep14762 PubMedPubMedCentralCrossRef

55.

Zhao LL, Wang YB, Suo L (2011) Meta-analysis of the risk factors for coronary artery lesion secondary to Kawasaki disease in Chinese children. Zhonghua Er Ke Za Zhi 49:459–467PubMed

56.

Orenstein JM, Shulman ST, Fox LM et al (2012) Three linked vasculopathic processes characterize Kawasaki disease: a light and transmission electron microscopic study. PLoS One 7:e38998. doi:10.1371/journal.pone.0038998 PubMedPubMedCentralCrossRef

57.

Lin IC, Kuo HC, Lin YJ et al (2012) Augmented TLR2 expression on monocytes in both human Kawasaki disease and a mouse model of coronary arteritis. PLoS One 7:e38635. doi:10.1371/journal.pone.0038635 PubMedPubMedCentralCrossRef

58.

Lin IC, Suen JL, Huang SK et al (2013) Dectin-1/Syk signaling is involved in Lactobacillus casei cell wall extract-induced mouse model of Kawasaki disease. Immunobiology 218:201–212. doi:10.1016/j.imbio.2012.04.004 PubMedCrossRef

59.

Nishio H, Kanno S, Onoyama S et al (2011) Nod1 ligands induce site-specific vascular inflammation. Arterioscler Thromb Vasc Biol 31:1093–1099. doi:10.1161/ATVBAHA.110.216325 PubMedCrossRef

60.

Nakamura Y, Aso E, Yashiro M et al (2013) Mortality among Japanese with a history of Kawasaki disease: results at the end of 2009. J Epidemiol 23:429–434PubMedCrossRef

61.

Niedra E, Chahal N, Manlhiot C, Yeung RS, McCrindle BW (2014) Atorvastatin safety in Kawasaki disease patients with coronary artery aneurysms. Pediatr Cardiol 35:89–92. doi:10.1007/s00246-013-0746-9 PubMedCrossRef

62.

Mori M, Imagawa T, Hara R et al (2012) Efficacy and limitation of infliximab treatment for children with Kawasaki disease intractable to intravenous immunoglobulin therapy: report of an open-label case series. J Rheumatol 39:864–867. doi:10.3899/jrheum.110877 PubMedCrossRef

63.

Tremoulet AH, Jain S, Jaggi P et al (2014) Infliximab for intensification of primary therapy for Kawasaki disease: a phase 3 randomised, double-blind, placebo-controlled trial. Lancet 383:1731–1738. doi:10.1016/s0140-6736(13)62298-9 PubMedCrossRef

64.

Millar K, Manlhiot C, Yeung RS, Somji Z, McCrindle BW (2012) Corticosteroid administration for patients with coronary artery aneurysms after Kawasaki disease may be associated with impaired regression. Int J Cardiol 154:9–13. doi:10.1016/j.ijcard.2010.08.070 PubMedCrossRef

65.

Adachi S, Sakaguchi H, Kuwahara T et al (2010) High regression rate of coronary aneurysms developed in patients with immune Globulin-Resistant Kawasaki disease treated with steroid pulse therapy. Tohoku J Exp Med 220:285–290. doi:10.1620/tjem.220.285 PubMedCrossRef

66.

Chen S, Dong Y, Yin Y, Krucoff MW (2013) Intravenous immunoglobulin plus corticosteroid to prevent coronary artery abnormalities in Kawasaki disease: a meta-analysis. Heart 99:76–82. doi:10.1136/heartjnl-2012-302126 PubMedCrossRef

67.

Harada M, Yokouchi Y, Oharaseki T et al (2012) Histopathological characteristics of myocarditis in acute-phase Kawasaki disease. Histopathology 61:1156–1167. doi:10.1111/j.1365-2559.2012.04332.x PubMedCrossRef

68.

Tacke CE, Romeih S, Kuipers IM et al (2013) Evaluation of cardiac function by magnetic resonance imaging during the follow-up of patients with Kawasaki disease. Circ Cardiovasc Imaging 6:67–73. doi:10.1161/circimaging.112.976969 PubMedCrossRef

69.

McCandless RT, Minich LL, Wilkinson SE et al (2013) Myocardial strain and strain rate in Kawasaki disease. Eur Heart J Cardiovasc Imaging 14:1061–1068. doi:10.1093/ehjci/jet041 PubMedCrossRef

70.

Ichida F, Fatica NS, O’Loughlin JE et al (1988) Correlation of electrocardiographic and echocardiographic changes in Kawasaki syndrome. Am Heart J 116:812–819PubMedCrossRef

71.

Ghelani SJ, Singh S, Manojkumar R (2011) QT interval dispersion in North Indian children with Kawasaki disease without overt coronary artery abnormalities. Rheumatol Int 31:301–305. doi:10.1007/s00296-009-1252-5 PubMedCrossRef

72.

Oyamada J, Toyono M, Shimada S, Aoki-Okazaki M, Takahashi T (2012) Altered central aortic elastic properties in Kawasaki disease are related to changes in left ventricular geometry and coronary artery aneurysm formation. J Am Soc Echocardiogr 25:690–696. doi:10.1016/j.echo.2012.03.003 PubMedCrossRef

73.

AlHuzaimi A, Al Mashham Y, Potts JE, De Souza AM, Sandor GG (2013) Echo-Doppler assessment of arterial stiffness in pediatric patients with Kawasaki disease. J Am Soc Echocardiogr 26:1084–1089. doi:10.1016/j.echo.2013.05.015 PubMedCrossRef

74.

Shah V, Christov G, Mukasa T et al (2015) Cardiovascular status after Kawasaki disease in the UK. Heart 101:1646–1655. doi:10.1136/heartjnl-2015-307734 PubMedPubMedCentralCrossRef

75.

Ishikawa K, Maetani S (1994) Long-term outcome for 120 Japanese patients with Takayasu’s disease. Clinical and statistical analyses of related prognostic factors. Circulation 90:1855–1860PubMedCrossRef

76.

Endo M, Tomizawa Y, Nishida H et al (2003) Angiographic findings and surgical treatments of coronary artery involvement in Takayasu arteritis. J Thorac Cardiovasc Surg 125:570–577. doi:10.1067/mtc.2003.39 PubMedCrossRef

77.

Comarmond C, Cluzel P, Toledano D et al (2014) Findings of cardiac magnetic resonance imaging in asymptomatic myocardial ischemic disease in Takayasu arteritis. Am J Cardiol 113:881–887. doi:10.1016/j.amjcard.2013.11.045 PubMedCrossRef

78.

Lee GY, Jang SY, Ko SM et al (2012) Cardiovascular manifestations of Takayasu arteritis and their relationship to the disease activity: analysis of 204 Korean patients at a single center. Int J Cardiol 159:14–20. doi:10.1016/j.ijcard.2011.01.094 PubMedCrossRef

79.

Li C, Liu Y, Qi R et al (2013) Repair of aortic regurgitation due to Takayasu arteritis. Heart Surg Forum 16:E24–E26. doi:10.1532/hsf98.20121059 PubMedCrossRef

80.

Misra R, Aggarwal A, Chag M, Sinha N, Shrivastava S (1994) Raised anticardiolipin antibodies in Takayasu’s arteritis. Lancet 343:1644–1645PubMedCrossRef

81.

Jordan NP, Bezanahary H, D’Cruz DP (2015) Increased risk of vascular complications in Takayasu’s arteritis patients with positive lupus anticoagulant. Scand J Rheumatol 44:211–214. doi:10.3109/03009742.2014.964305 PubMedCrossRef

82.

Castellani M, Vanoli M, Cali G et al (2001) Ventilation-perfusion lung scan for the detection of pulmonary involvement in Takayasu’s arteritis. Eur J Nucl Med 28:1801–1805. doi:10.1007/s002590100648 PubMedCrossRef

83.

Wang X, Dang A, Chen B, Lv N, Liu Q (2015) Takayasu arteritis-associated pulmonary hypertension. J Rheumatol 42:495–503. doi:10.3899/jrheum.140436 PubMedCrossRef

84.

Dong H, Jiang X, Peng M et al (2014) Percutaneous transluminal angioplasty for symptomatic pulmonary stenosis in Takayasu arteritis. J Rheumatol 41:1856–1862. doi:10.3899/jrheum.131007 PubMedCrossRef

85.

Kim GB, Kwon BS, Bae EJ, Noh CI (2012) Takayasu arteritis presenting as dilated cardiomyopathy with left ventricular thrombus in association with ulcerative colitis. J Am Coll Cardiol 60:e25. doi:10.1016/j.jacc.2011.11.080 PubMedCrossRef

86.

Seker T, Baykan AO, Borekci A, Gur M, Cayli M (2014) Successful treatment of a huge thrombus with thrombolytic therapy in a patient with normal left ventricle function and Takayasu arteritis. Turk Kardiyol Dern Ars 42:763–766. doi:10.5543/tkda.2014.60687 PubMedCrossRef

87.

da Silva TF, Levy-Neto M, Bonfa E, Pereira RM (2013) High prevalence of metabolic syndrome in Takayasu arteritis: increased cardiovascular risk and lower adiponectin serum levels. J Rheumatol 40:1897–1904. doi:10.3899/jrheum.130162 PubMedCrossRef

88.

Matsue Y, Ohno M, Nagahori W et al (2011) A case of giant cell arteritis with massive pericardial effusion. Heart Vessels 26:562–564. doi:10.1007/s00380-010-0101-5 PubMedCrossRef

89.

Kimura T, Komura M, Okubo Y (2012) Atypical giant cell arteritis predominantly involving intramural coronary arteries: a case showing refractory dialysis-related hypotension. Heart Vessels 27:216–220. doi:10.1007/s00380-011-0158-9 PubMedCrossRef

90.

Strecker T, Zimmermann S, Wachter DL, Agaimy A (2011) Aortic dissection caused by giant cell arteritis. Heart Surg Forum 14:E137–E138. doi:10.1532/hsf98.20101114 PubMedCrossRef

91.

Tomasson G, Peloquin C, Mohammad A et al (2014) Risk for cardiovascular disease early and late after a diagnosis of giant-cell arteritis: a cohort study. Ann Intern Med 160:73–80. doi:10.7326/m12-3046 PubMedPubMedCentralCrossRef

92.

Schmidt J, Kermani TA, Muratore F et al (2013) Statin use in giant cell arteritis: a retrospective study. J Rheumatol 40:910–915. doi:10.3899/jrheum.121150 PubMedPubMedCentralCrossRef

93.

Gasparovic H, Djuric Z, Bosnic D et al (2011) Aortic root vasculitis associated with Cogan’s syndrome. Ann Thorac Surg 92:340–341. doi:10.1016/j.athoracsur.2010.12.068 PubMedCrossRef

94.

Weyn T, Haine S, Conraads V (2009) Cogan’s syndrome with left main coronary artery occlusion. Cardiol J 16:573–576PubMed

95.

Geri G, Wechsler B, Thi Huong du L et al (2012) Spectrum of cardiac lesions in Behcet disease: a series of 52 patients and review of the literature. Medicine (Baltimore) 91:25–34. doi:10.1097/MD.0b013e3182428f49 CrossRef

96.

Bonitsis NG, Luong Nguyen LB, LaValley MP et al (2015) Gender-specific differences in Adamantiades–Behcet’s disease manifestations: an analysis of the German registry and meta-analysis of data from the literature. Rheumatology (Oxford) 54:121–133. doi:10.1093/rheumatology/keu247 CrossRef

97.

Emmungil H, Yasar Bilge NS, Kucuksahin O et al (2014) A rare but serious manifestation of Behcet’s disease: intracardiac thrombus in 22 patients. Clin Exp Rheumatol 32:S87–S92PubMed

98.

La Regina M, Gasparyan AY, Orlandini F, Prisco D (2010) Behcet’s disease as a model of venous thrombosis. Open Cardiovasc Med J 4:71–77. doi:10.2174/1874192401004020071 PubMedPubMedCentral

99.

Yue C, Li J, Li M et al (2012) Cardiac mass in Behcet’s disease. Clin Exp Rheumatol 30:S27–S31PubMed

100.

Ma WG, Zheng J, Zhu JM et al (2012) Aortic regurgitation caused by Behcet’s disease: surgical experience during an 11-year period. J Card Surg 27:39–44. doi:10.1111/j.1540-8191.2011.01392.x PubMedCrossRef

101.

Ulusan Z, Karadag AS, Tasar M, Kalender M, Darcin OT (2014) Behcet’s disease and cardiovascular involvement: our experience of asymptomatic Behcet’s patients. Cardiovasc J Afr 25:63–66. doi:10.5830/CVJA-2014-003 PubMedPubMedCentralCrossRef

102.

Demirelli S, Degirmenci H, Bilen H et al (2014) Left ventricular mechanics in Behcet’s disease: a speckle tracking echocardiographic study. Bosn J Basic Med Sci 14:160–164. doi:10.17305/bjbms.2014.3.2 PubMedPubMedCentralCrossRef

103.

Yagmur J, Sener S, Acikgoz N et al (2011) Subclinical left ventricular dysfunction in Behcet’s disease assessed by two-dimensional speckle tracking echocardiography. Eur J Echocardiogr 12:536–541. doi:10.1093/ejechocard/jer088 PubMedCrossRef

104.

Cobankara V, Guclu A, Kuru O et al (2012) Evaluation of biventricular myocardial performance index in patients with Behcet’s disease. J Int Med Res 40:328–332PubMedCrossRef

105.

Cansel M, Yagmur J, Tasolar H et al (2014) Assessment of atrial conduction time in patients with Behcet’s disease. Acta Reumatol Port 39:29–36PubMed

106.

Sayin MR, Akpinar I, Gursoy YC et al (2013) Assessment of QRS duration and presence of fragmented QRS in patients with Behcet’s disease. Coron Artery Dis 24:398–403. doi:10.1097/MCA.0b013e328361a978 PubMedCrossRef

107.

Karabag T, Aydin M, Dogan SM et al (2012) Investigation of the atrial electromechanical delay duration in Behcet patients by tissue Doppler echocardiography. Eur Heart J Cardiovasc Imaging 13:251–256. doi:10.1093/ejechocard/jer227 PubMedCrossRef

108.

Borman P, Tuncay F, Kocaoglu S et al (2012) The subclinic autonomic dysfunction in patients with Behcet disease: an electrophysiological study. Clin Rheumatol 31:41–47. doi:10.1007/s10067-011-1763-9 PubMedCrossRef

109.

Pandey A, Garg J, Krishnamoorthy P et al (2014) Predictors of coronary artery disease in patients with Behçet’s disease. Cardiology (Switzerland) 129:203–206. doi:10.1159/000365139

110.

Tasolar H, Tasolar S, Kurtulus D et al (2014) Increased epicardial adipose tissue thickness on transthoracic echocardiography in patients with Behcet disease. J Ultrasound Med 33:1393–1400. doi:10.7863/ultra.33.8.1393 PubMedCrossRef

111.

Kocabay G, Hasdemir H, Yildiz M (2012) Evaluation of pulse wave velocity in systemic lupus erythematosus, rheumatoid arthritis and Behcet’s disease. J Cardiol 59:72–77. doi:10.1016/j.jjcc.2011.09.004 PubMedCrossRef

112.

Balta I, Balta S, Koryurek OM et al (2014) Mean platelet volume is associated with aortic arterial stiffness in patients with Behcet’s disease without significant cardiovascular involvement. J Eur Acad Dermatol Venereol 28:1388–1393. doi:10.1111/jdv.12297 PubMedCrossRef

113.

Botsios C, Sfriso P, Punzi L, Todesco S (2007) Non-complementaemic urticarial vasculitis: successful treatment with the IL-1 receptor antagonist, anakinra. Scand J Rheumatol 36:236–237. doi:10.1080/03009740600938647 PubMedCrossRef

114.

Boyer EM, Turman M, O’Neil KM (2011) Partial response to anakinra in life-threatening Henoch–Schönlein purpura: case report. Pediatr Rheumatol Online J 9:21. doi:10.1186/1546-0096-9-21 PubMedPubMedCentralCrossRef

115.

Wei L, MacDonald TM, Walker BR (2004) Taking glucocorticoids by prescription is associated with subsequent cardiovascular disease. Ann Intern Med 141:764–770PubMedCrossRef

116.

Souverein PC, Berard A, Van Staa TP et al (2004) Use of oral glucocorticoids and risk of cardiovascular and cerebrovascular disease in a population based case-control study. Heart 90:859–865. doi:10.1136/hrt.2003.020180 PubMedPubMedCentralCrossRef

117.

Varas-Lorenzo C, Rodriguez LA, Maguire A, Castellsague J, Perez-Gutthann S (2007) Use of oral corticosteroids and the risk of acute myocardial infarction. Atherosclerosis 192:376–383. doi:10.1016/j.atherosclerosis.2006.05.019 PubMedCrossRef

118.

Dadfarmay S, Berkowitz R, Kim B (2012) Irreversible end-stage cardiomyopathy following a single dose of cyclophosphamide. Congest Heart Fail 18:234–237. doi:10.1111/j.1751-7133.2011.00279.x PubMedCrossRef

119.

Agarwal N, Burkart TA (2013) Transient, high-grade atrioventricular block from high-dose cyclophosphamide. Tex Heart Inst J 40:626–627PubMedPubMedCentral

120.

Zhou F, Ling C, Guo L et al (2014) Continuous low-dose cyclophosphamide and prednisone in the treatment of relapsed/refractory multiple myeloma with severe heart failure. Leuk Lymphoma 55:2271–2276. doi:10.3109/10428194.2014.887711 PubMedCrossRef

121.

Ajeganova S, de Faire U, Jogestrand T, Frostegard J, Hafstrom I (2012) Carotid atherosclerosis, disease measures, oxidized low-density lipoproteins, and atheroprotective natural antibodies for cardiovascular disease in early rheumatoid arthritis—an inception cohort study. J Rheumatol 39:1146–1154. doi:10.3899/jrheum.111334 PubMedCrossRef

122.

Ahlehoff O, Skov L, Gislason G et al (2015) Cardiovascular outcomes and systemic anti-inflammatory drugs in patients with severe psoriasis: 5-year follow-up of a Danish nationwide cohort. J Eur Acad Dermatol Venereol 29:1128–1134. doi:10.1111/jdv.12768 PubMedCrossRef

123.

Westlake SL, Colebatch AN, Baird J et al (2010) The effect of methotrexate on cardiovascular disease in patients with rheumatoid arthritis: a systematic literature review. Rheumatology (Oxford) 49:295–307. doi:10.1093/rheumatology/kep366 CrossRef

124.

Micha R, Imamura F, Wyler von Ballmoos M et al (2011) Systematic review and meta-analysis of methotrexate use and risk of cardiovascular disease. Am J Cardiol 108:1362–1370. doi:10.1016/j.amjcard.2011.06.054 PubMedPubMedCentralCrossRef

125.

De Vecchis R, Baldi C, Palmisani L (2015) Protective effects of methotrexate against ischemic cardiovascular disorders in patients treated for rheumatoid arthritis or psoriasis: novel therapeutic insights coming from a meta-analysis of the literature data. Anatol J Cardiol. doi:10.5152/akd.2015.6136

126.

Thornton CC, Al-Rashed F, Calay D et al (2015) Methotrexate-mediated activation of an AMPK-CREB-dependent pathway: a novel mechanism for vascular protection in chronic systemic inflammation. Ann Rheum Dis. doi:10.1136/annrheumdis-2014-206305 PubMed

127.

Ronda N, Greco D, Adorni MP et al (2015) Newly identified antiatherosclerotic activity of methotrexate and adalimumab: complementary effects on lipoprotein function and macrophage cholesterol metabolism. Arthritis Rheumatol 67:1155–1164. doi:10.1002/art.39039 PubMedCrossRef

128.

Bulgarelli A, Leite AC Jr, Dias AA, Maranhao RC (2013) Anti-atherogenic effects of methotrexate carried by a lipid nanoemulsion that binds to LDL receptors in cholesterol-fed rabbits. Cardiovasc Drugs Ther 27:531–539. doi:10.1007/s10557-013-6488-3 PubMedCrossRef

129.

Moreira DM, Lueneberg ME, da Silva RL, Fattah T, Mascia Gottschall CA (2013) Rationale and design of the TETHYS trial: the effects of methotrexate therapy on myocardial infarction with ST-segment elevation. Cardiology 126:167–170. doi:10.1159/000351972 PubMedCrossRef

130.

Zanoli L, Rastelli S, Inserra G et al (2014) Increased arterial stiffness in inflammatory bowel diseases is dependent upon inflammation and reduced by immunomodulatory drugs. Atherosclerosis 234:346–351. doi:10.1016/j.atherosclerosis.2014.03.023 PubMedCrossRef

131.

Pols TW, Bonta PI, Pires NM et al (2010) 6-Mercaptopurine inhibits atherosclerosis in apolipoprotein e*3-leiden transgenic mice through atheroprotective actions on monocytes and macrophages. Arterioscler Thromb Vasc Biol 30:1591–1597. doi:10.1161/atvbaha.110.205674 PubMedCrossRef

132.

Spagnoletti G, Citterio F, Favi E et al (2009) Cardiovascular risk profile in kidney transplant recipients treated with two immunosuppressive regimens: tacrolimus and mycophenolate mofetil versus everolimus and low-dose cyclosporine. Transpl Proc 41:1175–1177. doi:10.1016/j.transproceed.2009.03.045 CrossRef

133.

Cuervas-Mons V, Herrero JI, Gomez MA et al (2015) Impact of tacrolimus and mycophenolate mofetil regimen vs. a conventional therapy with steroids on cardiovascular risk in liver transplant patients. Clin Transplant 29:667–677. doi:10.1111/ctr.12557 PubMedCrossRef

134.

van Leuven SI, Mendez-Fernandez YV, Wilhelm AJ et al (2012) Mycophenolate mofetil but not atorvastatin attenuates atherosclerosis in lupus-prone LDLr(−/−) mice. Ann Rheum Dis 71:408–414. doi:10.1136/annrheumdis-2011-200071 PubMedCrossRef

135.

van Sijl AM, van der Weele W, Nurmohamed MT (2014) Myocardial infarction after rituximab treatment for rheumatoid arthritis: is there a link? Curr Pharm Des 20:496–499PubMedCrossRef

136.

Passalia C, Minetto P, Arboscello E et al (2013) Cardiovascular adverse events complicating the administration of rituximab: report of two cases. Tumori 99:288e–292e. doi:10.1700/1390.15471 PubMed

137.

Fernandez-Nebro A, Marenco JL, Lopez-Longo F et al (2014) The effects of rituximab on the lipid profile of patients with active systemic lupus erythematosus: results from a nationwide cohort in Spain (LESIMAB). Lupus 23:1014–1022. doi:10.1177/0961203314534909 PubMedCrossRef

138.

Raterman HG, Levels H, Voskuyl AE et al (2013) HDL protein composition alters from proatherogenic into less atherogenic and proinflammatory in rheumatoid arthritis patients responding to rituximab. Ann Rheum Dis 72:560–565. doi:10.1136/annrheumdis-2011-201228 PubMedCrossRef

139.

Provan SA, Berg IJ, Hammer HB et al (2015) The impact of newer biological disease modifying anti-rheumatic drugs on cardiovascular risk factors: a 12-month longitudinal study in rheumatoid arthritis patients treated with rituximab, abatacept and tociliziumab. PLoS One 10:e0130709. doi:10.1371/journal.pone.0130709 PubMedPubMedCentralCrossRef

140.

Hsue PY, Scherzer R, Grunfeld C et al (2014) Depletion of B-cells with rituximab improves endothelial function and reduces inflammation among individuals with rheumatoid arthritis. J Am Heart Assoc 3:e001267. doi:10.1161/jaha.114.001267 PubMedPubMedCentralCrossRef

141.

Clifford A, Hoffman GS (2014) Recent advances in the medical management of Takayasu arteritis: an update on use of biologic therapies. Curr Opin Rheumatol 26:7–15. doi:10.1097/bor.0000000000000004 PubMedCrossRef

142.

Levine B, Kalman J, Mayer L, Fillit HM, Packer M (1990) Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N Engl J Med 323:236–241. doi:10.1056/nejm199007263230405 PubMedCrossRef

143.

Chung ES, Packer M, Lo KH, Fasanmade AA, Willerson JT (2003) Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: results of the anti-TNF Therapy Against Congestive Heart Failure (ATTACH) trial. Circulation 107:3133–3140. doi:10.1161/01.cir.0000077913.60364.d2 PubMedCrossRef

144.

Solomon DH, Rassen JA, Kuriya B et al (2013) Heart failure risk among patients with rheumatoid arthritis starting a TNF antagonist. Ann Rheum Dis 72:1813–1818. doi:10.1136/annrheumdis-2012-202136 PubMedCrossRef

145.

Westlake SL, Colebatch AN, Baird J et al (2011) Tumour necrosis factor antagonists and the risk of cardiovascular disease in patients with rheumatoid arthritis: a systematic literature review. Rheumatology (Oxford) 50:518–531. doi:10.1093/rheumatology/keq316 CrossRef

146.

Roubille C, Richer V, Starnino T et al (2015) The effects of tumour necrosis factor inhibitors, methotrexate, non-steroidal anti-inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review and meta-analysis. Ann Rheum Dis 74:480–489. doi:10.1136/annrheumdis-2014-206624 PubMedPubMedCentralCrossRef

147.

Souto A, Salgado E, Maneiro JR et al (2015) Lipid profile changes in patients with chronic inflammatory arthritis treated with biologic agents and tofacitinib in randomized clinical trials: a systematic review and meta-analysis. Arthritis Rheumatol 67:117–127. doi:10.1002/art.38894 PubMedCrossRef

148.

Strang AC, Bisoendial RJ, Kootte RS et al (2013) Pro-atherogenic lipid changes and decreased hepatic LDL receptor expression by tocilizumab in rheumatoid arthritis. Atherosclerosis 229:174–181. doi:10.1016/j.atherosclerosis.2013.04.031 PubMedCrossRef

149.

Schultz O, Oberhauser F, Saech J et al (2010) Effects of inhibition of interleukin-6 signalling on insulin sensitivity and lipoprotein (a) levels in human subjects with rheumatoid diseases. PLoS One 5:e14328. doi:10.1371/journal.pone.0014328 PubMedPubMedCentralCrossRef

150.

Kume K, Amano K, Yamada S et al (2011) Tocilizumab monotherapy reduces arterial stiffness as effectively as etanercept or adalimumab monotherapy in rheumatoid arthritis: an open-label randomized controlled trial. J Rheumatol 38:2169–2171. doi:10.3899/jrheum.110340 PubMedCrossRef

151.

Lazzerini PE, Acampa M, Capecchi PL et al (2015) Antiarrhythmic potential of anticytokine therapy in rheumatoid arthritis: tocilizumab reduces corrected QT interval by controlling systemic inflammation. Arthritis Care Res (Hoboken) 67:332–339. doi:10.1002/acr.22455 CrossRef

152.

Ursini F, Mauro D, Naty S, Gagliardi D, Grembiale RD (2012) Improvement in insulin resistance after short-term treatment with abatacept: case report and short review. Clin Rheumatol 31:1401–1402. doi:10.1007/s10067-012-2034-0 PubMedCrossRef

153.

Ursini F, Russo E, Letizia Hribal M et al (2015) Abatacept improves whole-body insulin sensitivity in rheumatoid arthritis: an observational study. Medicine (Baltimore) 94:e888. doi:10.1097/md.0000000000000888 CrossRef

154.

Mathieu S, Couderc M, Glace B et al (2013) Effects of 6 months of abatacept treatment on aortic stiffness in patients with rheumatoid arthritis. Biologics 7:259–264. doi:10.2147/btt.s52003 PubMedPubMedCentral

155.

Vanrenterghem Y, Bresnahan B, Campistol J et al (2011) Belatacept-based regimens are associated with improved cardiovascular and metabolic risk factors compared with cyclosporine in kidney transplant recipients (BENEFIT and BENEFIT-EXT studies). Transplantation 91:976–983. doi:10.1097/TP.0b013e31820c10eb PubMedCrossRef

156.

Nowak C, Sundstrom J, Gustafsson S et al (2016) Protein biomarkers for insulin resistance and type 2 diabetes risk in two large community cohorts. Diabetes 65:276–284. doi:10.2337/db15-0881 PubMed

157.

Fragoso JM, Delgadillo H, Llorente L et al (2010) Interleukin 1 receptor antagonist polymorphisms are associated with the risk of developing acute coronary syndrome in Mexicans. Immunol Lett 133:106–111. doi:10.1016/j.imlet.2010.08.003 PubMedCrossRef

158.

Johansen NB, Vistisen D, Brunner EJ et al (2012) Determinants of aortic stiffness: 16-year follow-up of the Whitehall II study. PLoS One 7:e37165. doi:10.1371/journal.pone.0037165 PubMedPubMedCentralCrossRef

159.

Ikonomidis I, Tzortzis S, Lekakis J et al (2011) Association of soluble apoptotic markers with impaired left ventricular deformation in patients with rheumatoid arthritis. Effects of inhibition of interleukin-1 activity by anakinra. Thromb Haemost 106:959–967. doi:10.1160/th11-02-0117 PubMedCrossRef

160.

Ridker PM, Howard CP, Walter V et al (2012) Effects of interleukin-1beta inhibition with canakinumab on hemoglobin A1c, lipids, C-reactive protein, interleukin-6, and fibrinogen: a phase IIb randomized, placebo-controlled trial. Circulation 126:2739–2748. doi:10.1161/circulationaha.112.122556 PubMedCrossRef

161.

Ridker PM (2013) Closing the loop on inflammation and atherothrombosis: why perform the CIRT and CANTOS trials? Trans Am Clin Climatol Assoc 124:174–190PubMedPubMedCentral

Titel: Cardiac involvement in primary systemic vasculitis and potential drug therapies to reduce cardiovascular risk
verfasst von: Durga Prasanna Misra
Sajjan N. Shenoy
Publikationsdatum: 17.02.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Rheumatology International / Ausgabe 1/2017
Print ISSN: 0172-8172
Elektronische ISSN: 1437-160X
DOI: https://doi.org/10.1007/s00296-016-3435-1

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2017

Takayasu arteritis (TA) first presenting with intestinal ischemia: a case report and review of gastrointestinal tract involvement (ischemic and non-ischemic) associated with TA

An overview of treatment approaches for chronic pain management

Cardiac mechanics and heart rate variability in patients with systemic sclerosis: the association that we should not miss

Cardiovascular risk and inflammation in rheumatic diseases

Polymyalgia rheumatica and risk of coronary artery disease: a systematic review and meta-analysis of observational studies