Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose
Ankylosing spondylitis (AS) is associated with an increased cardiovascular (CV) risk that is caused by accelerated atherosclerosis as well as specific cardiac manifestations: valvular disease, conduction disturbances and congestive heart failure due to decreased ventricular function. In this study we investigated the prevalence of cardiac disease in AS patients with high disease activity.
Methods
We performed a cross sectional study in patients with AS eligible for treatment with TNF blocking therapy. 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 assess systolic left ventricular (LV) function, with systolic LV dysfunction defined as EF<50%. For diastolic LV function a combination of echocardiographic measurements, i.e. 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 LV dysfunction is graded into three categories: mild (grade I), pseudonormal (grade II) and restrictive (grade III). Valvular and aortic abnormalities were evaluated according to the current echocardiographic guidelines. Data was compared with data from literature using one-sample t-test.
Results
Forty-three consecutive AS patients were included with a mean age of 43±12 years and a mean disease duration of 10±12 years. In total, 10 out of 43 (23%) patients had diastolic LV dysfunction grade I, of which one was female. This was significantly higher compared to literature, in which the prevalence of diastolic LV dysfunction grade I is approximately 5% in an age matched control group (p<0.01)1. Two patients had a prior myocardial infarction of which one had systolic LV dysfunction, with an EF of 49%. Three patients had mild aortic regurgitation and seven other patients had mild mitral regurgitation. Five patients had mild aortic dilatation. Overall, 19 out of 43 AS patients (44%) had some form of cardiac dysfunction or disease which is substantially higher compared to the general population, as the prevalence of cardiac disease in the general population is approximately 8% 2.
Conclusion
Patients with AS have an increased prevalence of cardiac disease compared with the general population, with increased prevalence’s of left ventricular dysfunction and valvular disease. This increased prevalence may increase CV risk in AS patients. As cardiac disease could be attributable to the general inflammation process affecting the heart, further studies are warranted that investigate whether or not anti-inflammatory treatment, such as TNF blockers, improves cardiac function or prevents early cardiac complications. Also, the impact of (mandatory) screening AS patients with echocardiography on CV disease should be investigated.
Disclosure:
S. C. Heslinga,
None;
T. C. Konings,
None;
I. E. Van der Horst – Bruinsma,
None;
M. L. John,
None;
M. T. Nurmohamed,
Abbott, Roche, Pfizer,
8.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/unexpected-high-prevalence-of-cardiac-disease-in-patients-with-ankylosing-spondylitis/