Background/Purpose:

Patients with ankylosing spondylitis (AS) have an increased cardiovascular risk leading to decreased life expectancy. This is due to both accelerated atherosclerotic disease as well as cardiac morbidity such as valvular disease and congestive heart failure. In this study we investigated the prevalence of cardiac disease with echocardiography in patients with AS who were eligible for TNF-blocking therapy. 

Methods:

We performed a cross sectional study on consecutive patients with AS starting treatment with a TNF-blocker. Patients were screened for cardiac disease using standard transthoracic echocardiography that included two-dimensional, three-dimensional and M-mode echocardiography, spectral Doppler, color Doppler and tissue Doppler imaging. The ejection fraction (EF) was used to describe systolic function, with systolic dysfunction defined as EF<50%. For diastolic function a combination of echocardiographic measurements, namely peak early diastolic filling velocity (E), late diastolic filling velocity (A), E/A ratio, early diastolic mitral annular velocity (E’), deceleration time (DT) and isovolumetric relaxation time (IVRT) were used. Based on these parameters diastolic dysfunction is graded into three categories: mild (grade I), pseudonormal (grade II) and restrictive (grade III). Valvular abnormalities were evaluated according to the current echocardiographic guidelines. Disease activity was measured using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Blood pressure, serum glucose, total cholesterol, triglycerides, low density lipoprotein (LDL), high density lipoprotein (HDL), c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured. Data was compared with data from literature using one-sample t-test. 

Results:

17 AS patients were included with a mean age of 44±11 years and a disease duration of 18±10 years (Tabel1). In total, 5 out of 17 (29%) patients had diastolic dysfunction grade I, of which one was female. This was significantly higher compared to literature, in which the prevalence of diastolic dysfunction grade I is approximately 5% in an age and sex-matched control group (p=0.046). One patient had systolic dysfunction, with an EF of 49%, but had suffered from a myocardial infarction in the past. Two patients had mild aortic regurgitation and two other patients had mild mitral regurgitation (23.5%). Overall, 7 out of 17 (41.1%) patients had some form of cardiac dysfunction or disease.

Conclusion:

Patients with AS have an increased prevalence of diastolic dysfunction compared with the general population. This may be attributable to the general inflammation process that results in a decreased relaxation ability of the left ventricle as well as compromised valve cups function. As diastolic heart failure is associated with increased mortality, diastolic dysfunction in AS patients might have an important role in the increased cardiovascular risk

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/high-prevalence-of-left-ventricular-diastolic-dysfunction-in-patients-with-ankylosing-spondylitis/