Long-Term Outcomes of Aortic Valve Insufficiency in Patients with Takayasu Arteritis

Feyyaz Hazar Yagmur¹Muhammed Emin Kutu²Fatih Tastekin³Aysegul Avci⁴Senar San⁵Tugba Ocak⁶Fatih Yildirim⁷Hasan Kocaayan⁸Safiye Bakkal⁹Sema Isik¹⁰Burcu Ceren Uludogan¹¹Semiha Koroglu³Gokce Kenar¹²Yavuz Pehlivan⁶Ayse Cefle⁵Ayten Yazici⁵Sule Yasar Bilge¹³Servet Akar⁸Ahmet Omma¹⁰Fatos Onen⁹Cemal Bes⁷Fatma Alibaz Oner⁴Haner Direskeneli⁴Kenan Aksu³Gokhan Keser³Nilufer Alpay Kanitez^14*

• ¹Department of Internal Medicine, Koc Universitesi Tip Fakultesi, Istanbul, Türkiye
• ²Department of Internal Medicine, Division of Rheumatology, TC Saglik Bakanligi Bakirkoy Dr Sadi Konuk Egitim ve Arastirma Hastanesi, Bakırköy, Türkiye
• ³Department of Internal Medicine, Division of Rheumatology, Ege Universitesi Tip Fakultesi, Izmir, Türkiye
• ⁴Department of Internal Medicine, Division of Rheumatology, Marmara Universitesi Tip Fakultesi, Istanbul, Türkiye
• ⁵Department of Internal Medicine, Division of Rheumatology, Kocaeli Universitesi Tip Fakultesi, Izmit, Türkiye
• ⁶Department of Internal Medicine, Division of Rheumatology, Bursa Uludag Universitesi Tip Fakultesi, Nilüfer, Türkiye
• ⁷Department of Internal Medicine, Division of Rheumatology, TC Saglik Bakanligi Basaksehir Cam ve Sakura Sehir Hastanesi, Başakşehir, Türkiye
• ⁸Department of Internal Medicine, Division of Rheumatology, Izmir Katip Celebi Universitesi Tip Fakultesi, Izmir, Türkiye
• ⁹Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul Universitesi Tip Fakultesi, Izmir, Türkiye
• ¹⁰Department of Internal Medicine, Division of Rheumatology, TC Saglik Bakanligi Ankara Sehir Hastanesi, Çankaya, Türkiye
• ¹¹Department of Internal Medicine, Division of Rheumatology, Eskisehir Osmangazi Universitesi Tip Fakultesi, Eskişehir, Türkiye
• ¹²Dokuz Eylul Universitesi Tip Fakultesi, Izmir, Türkiye
• ¹³Eskisehir Osmangazi Universitesi Tip Fakultesi, Eskişehir, Türkiye
• ¹⁴Department of Internal Medicine, Division of Rheumatology, Koc Universitesi Tip Fakultesi, Istanbul, Türkiye

Objective: Takayasu arteritis (TAK) is a rare vasculitis predominantly affecting the aorta and its branches. Aortic valve (AV) insufficiency is a clinically significant but underexplored manifestation of TAK. This study aimed to evaluate the prevalence, associated risk factors, and prognostic implications of AV insufficiency in a large, multicenter cohort of TAK patients. Methods: We retrospectively analyzed data from 252 patients diagnosed with TAK across 11 rheumatology centers in Türkiye. Echocardiographic findings, clinical characteristics, treatment data, and long-term outcomes were collected. Severity and progression of AV insufficiency were assessed using standardized echocardiographic criteria. Results: AV insufficiency was present in 33% of patients, with moderate to severe forms observed in 12% and with 7% requiring valve replacement. Ascending aorta and renal artery involvement, hypertension, and heart failure were more frequent in patients with AV insufficiency. Over a median follow-up of 97 months, AV insufficiency progressed in 17% of baseline affected patients. The absence of subclavian artery involvement and vascular damage index (VDI) were found to be independent risk factors for AV insufficiency progression. Despite the structural progression, AV insufficiency did not significantly impact mortality, relapse rates, vascular damage index, or treatment patterns. Conclusion: AV insufficiency is the most clinically relevant valvular pathology in TAK, and its baseline presence did not adversely influence TAK disease outcomes. Progression was observed in a subset of patients, and this was associated with higher VDI scores, particularly among those without subclavian artery involvement. Timely diagnosis and multidisciplinary management may mitigate its impact on long-term outcomes.