Background Ankylosing spondylitis (AS) is associated with increased risk of cardiac disease, such as valvular regurgitation, conduction disturbances and decreased ventricular function . However, contemporary data are not available and therefore we investigated the prevalence of cardiac manifestations in AS patients between 50 and 75 years old.
Objectives To determine the prevalence of cardiac disease in older AS patients with and without a cardiovascular history.
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 Sixty-nine AS patients (18 females, 26%) with a mean age of 60±7 years and a mean disease duration of 22±13 years were included. 16 patients (23%) had a history of cardiovascular disease, including stroke (n=2), myocardial infarction (n=3), rhythm disorders (n=5), or a combination (n=6).
Of all patients, 33% had DD grade I, 13% DD grade II and 0% DD grade III and 3 patients (4%) had systolic LV dysfunction. In patients without a history of cardiovascular disease, a new cardiac abnormality was found on TTE in 14 (20%) which required treatment or follow-up by a cardiologist: ventricular dysfunction (n=2), aortic (root) dilatation (n=7), valvular regurgitation (n=2), rhythm disorders (n=1), other (n=1) or a combination (n=1).
Conclusions 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 cardiovascular morbidity and mortality. Obviously, the potential clinical impact and effect on cardiovascular mortality remains to be determined.
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.
Acknowledgements This study was partially financed by the Dutch Arthritis Association, The Netherlands
Disclosure of Interest None declared