084. DISCOVERY AND VALIDATION OF A NOVEL ANGIOGRAPHIC CLASSIFICATION SCHEME IN TAKAYASU’S ARTERITIS

Background: Takayasu’s arteritis (TAK) is characterized by variable patterns of damage throughout the large arteries. Methods: Data was used from patients with TAK from four independent cohorts: one in India and three in North America (NA). All patients underwent whole-body angiography of the aorta and branch vessels, with categorization of involvement (stenosis, occlusion, or aneurysm) in 13 arterial territories. K-means cluster analysis was performed to identify subgroups of patients based on pattern of angiographic involvement. Cluster groups were identified in the Indian cohort and independently validated in the NA cohorts. Results: 581 and 225 patients with TAK were included from the Indian and NA cohorts, respectively. Three distinct clusters were identified in the Indian cohort and validated in the NA cohorts. Patients in Cluster 1 had significantly more disease in the abdominal aorta, renal, and mesenteric arteries (p < 0.01). Patients in Cluster 2 had significantly more bilateral disease in the carotid and subclavian arteries (p < 0.01). Compared to Clusters 1 and 2, patients in Cluster 3 had asymmetric disease with fewer involved territories (p < 0.01). In the Indian and the NA cohorts, patients in Clusters 1 and 2 compared to Cluster 3 were more likely to have arterial occlusions (58% vs 82% vs 37%; p < 0.01) and a history of tuberculosis (8% vs 10% vs 3%; p = 0.03). Disease onset in childhood (28% vs 16% vs 19%; p < 0.01) and hypertension (71% vs 42% vs 39%; p < 0.01) were more common in Cluster 1. Stroke (0% vs 22% vs 5%; p = 0.03), vision loss (0% vs 33% vs 6%; p = 0.01), carotidynia (3% vs 26% vs 9%; p = 0.01) and persistent disease activity (46% vs 59% vs 44%; p = 0.02) were significantly more prevalent in Cluster 2. Conclusion: This large study in TAK identified and validated three novel subsets of patients based on patterns of arterial disease. Angiographic-based disease classification may help identify causal disease factors and enable stratified clinical decision making in this complex, clinically heterogeneous disease. Disclosures: Intramural NIAMS Program and the VCRC Abstract 084 Table 1: <0.01 Temporal artery examination abnormality defined as cord-like, tender, or absent/diminished pulse. Pulse abnorn1ality defined as reduced or absent pulse. LV involvement defined as presence of stenosis, occlusion, aneurysm, FDG uptake, or halo sign on angiogram (MR, CT, catheter), PET or ultrasound in the aorta or branch arteries (excluding temporal artery).

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