Background/Purpose:

Ankylosing spondylitis (AS) is associated with increased risk of concomitant cardiac disease, such as valvular regurgitation, conduction disturbances and decreased ventricular function (1). However, contemporary data are not available. Therefore, we investigated the prevalence of cardiac manifestations in AS patients between 50 and 75 years old.

Methods:

We performed a cross sectional study in randomly selected AS patients between 50 and 75 years old. Patients were screened for cardiac disease using standard transthoracic echocardiography (TTE) that included two-dimensional, three-dimensional and M-mode echocardiography, spectral Doppler, color Doppler and tissue Doppler imaging. Systolic left ventricular (LV) dysfunction was defined as an ejection fraction <50%. Diastolic LV dysfunction (DD) was graded into three categories: mild (grade I), pseudonormal (grade II) and restrictive (grade III). Valvular parameters and aortic diameters were evaluated according to the current echocardiographic guidelines.

Results:

One-hundred-ten AS patients (27 females, 25%) with a mean age of 60±7 years and a mean disease duration of 21±12 years were included. 24 patients (22%) had a history of CV disease, including stroke (n=2), myocardial infarction (n=4), rhythm disorders (n=8), other (n=4) or a combination (n=6).

Seven patients (6%) had systolic LV dysfunction. Of 107 patients diastolic LV function could be determined: 32% had DD grade I, 19% DD grade II and 0% DD grade III.

In patients without a history of CV disease, a new cardiac abnormality was found on TTE in 20 (18%) which required treatment or follow-up by a cardiologist: ventricular dysfunction (n=3), aortic (root) dilatation (n=10), valvular regurgitation (n=5), rhythm disorders (n=1), or a combination (n=1).

Conclusion:

In patients with a long duration of AS without a history of cardiac disease or symptoms, there is a high prevalence of cardiac manifestations, with high prevalences of LV dysfunction, valvular disease and aortic (root) dilatation. This high prevalence might ultimately translate into increased CV morbidity and mortality. The potential clinical impact and effect on CV mortality remains to be determined.

References:

1) Nurmohamed MT, van der Horst-Bruinsma I, Maksymowych WP. Cardiovascular and cerebrovascular diseases in ankylosing spondylitis: current insights. Curr Rheumatol Rep 2012 Oct;14(5):415-21.

Disclosures: This study was partly financed by the Dutch Arthritis Association, The Netherlands.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/high-prevalence-of-cardiac-disease-in-patients-with-ankylosing-spondylitis/