Session Information
Date: Sunday, November 13, 2016
Title: Imaging of Rheumatic Diseases - Poster I: Ultrasound and Emerging Technologies
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: The aim of our study was to describe the prevalence of diastolic dysfunction (DD) and structural heart disease (SHD) among a cohort of Axial Spondyloarthritis (AxSpA) patients matched with a healthy control population. Aortic dilation, aortic insufficiency (AI) and DD have been reported in Ankylosing Spondylitis (AS), although their true prevalence remains uncertain. New pharmacologic therapies for AxSpA may have further impacted the prevalence of heart disease in this population. Studies to date have been small and lacked control populations, resulting in controversial recommendations for routine echocardiographic screening in AxSpA patients.
Methods: Prospective transthoracic echocardiograms were performed on 125 AxSpA patients and 56 age-matched healthy controls. Leading edge aortic root (AoR) measurements were made and normalized for body surface area. Measurements were also taken at the aortic annulus, sino-tubular junction and ascending aorta. DD was graded in accordance with the American Society of Echocardiography guidelines. Chi square tests and Wilcoxan rank sum analyses were used in the univariate analysis. A subgroup analysis was also performed in a matched group of 90 AS patients meeting the modified New York criteria and 45 healthy controls.
Results: Participants were 68% male with a mean age of 42.8±12 years. Mean AxSpA disease duration was 18.2 ± 12 years. The modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) for the overall population was 7.1±14.5 units and 9.9±16.5 units for the AS population. Mean AoR diameter was 3.29±0.36 cm for cases and 3.24±0.32 cm for controls. There was no difference in linear aortic measurements, the presence of AI or DD between the two groups. The subgroup analysis of AS patients alone did not show any differences in these outcomes when compared to controls.
Conclusion: While there are differences among individual measurements used in the assessment of diastolic function, there is no clinically relevant difference in the prevalence of DD between cases and controls. Furthermore, there is no significant increase in AoR size or in the presence of AI in AxSpA patients when compared with healthy controls. These findings are the first basis of evidence to support the current recommendations against routine echocardiographic screening in asymptomatic AxSpA patients. Future subgroup analyses should focus on the impact of pharmacologic therapies on SHD and DD in this population.
| Table 1: Baseline Characteristics of the Study Population | ||
|
Population Characteristics |
AxSp Patients n=125 |
AS Patients n=90 |
|
Baseline disease activity (ASDAS – CRP) |
2.97 ± 1.25 |
3.09 ±1.35 |
|
Disease activity at time of echo (ASDAS – CRP) |
2.0 ± 0.89 |
1.99 ± 0.94 |
|
Baseline CRP (mg/L) Reference range <6.3 mg/L |
16.2 ± 22.7 |
13.6 ± 14.8 |
|
CRP at time of echo (mg/L) Reference range <6.3 mg/L |
5.5 ± 6.5 |
6.12 ± 6.84 |
|
Treatment with NSAIDs |
57.2% |
46% |
|
Treatment with TNFi |
52% |
56% |
| ASDAS – Ankylosing Spondylitis Disease Activity Score, CRP – C-Reactive Protein, NSAID – Non-steroidal Anti-inflammatory Drug, TNF-i – Tumor Necrosis Factor Inhibitor | ||
| Table 2: Echocardiographic Variables in the Study Population | ||||||||
| Variables |
AxSp Patients n=125 |
Controls n=56 |
95% CI |
p-value |
AS Patients n=90 |
Controls n=45 |
95% CI |
p-value |
|
Mean E wave velocity cm/s |
77 |
69.4 |
71.8, 76.9 |
0.01 |
76.5 |
69.6 |
71.1, 77.2 |
0.03 |
|
Mean A wave velocity cm/s |
58.4 |
48 |
52.8, 57.4 |
0.00 |
59.9 |
46.4 |
52.5, 58.0 |
0.00 |
|
Mean deceleration time ms |
195.3 |
212.9 |
194.6, 207.2 |
0.02 |
193.9 |
212.9 |
193.1, 207.7 |
0.03 |
|
Mean lateral e’ velocity cm/s |
12.7 |
14.3 |
12.7, 13.8 |
0.02 |
12.6 |
14.5 |
12.6, 13.9 |
0.08 |
|
Mean septal e’ velocity cm/s |
9.6 |
9.5 |
9.2, 10 |
0.77 |
9.5 |
9.6 |
9.0, 9.96 |
0.83 |
|
Diastolic dysfunction (grade 1 and above) |
22% |
23% |
− |
0.9 |
27% |
22% |
− |
0.58 |
|
AoR diameter > 1.96 Z score above predicted mean |
3% |
2% |
-0.3, -0.05 |
0.97 |
2% |
2% |
-0.37, -0.4 |
1.00 |
|
Aortic Insufficiency (trace and above) |
45% |
54% |
− |
0.27 |
49% |
53% |
− |
0.88 |
To cite this abstract in AMA style:
Reejhsinghani R, Becker K, Schiller N, Yoon G, Foster E, Gensler LS. Prevalence of Diastolic Dysfunction and Structural Heart Disease in Axial Spondyloarthritis: A Prospective Case Control Study Using Echocardiography [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/prevalence-of-diastolic-dysfunction-and-structural-heart-disease-in-axial-spondyloarthritis-a-prospective-case-control-study-using-echocardiography/. Accessed .ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-diastolic-dysfunction-and-structural-heart-disease-in-axial-spondyloarthritis-a-prospective-case-control-study-using-echocardiography/