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AB0666 Progression of Aortic and Valve Abnormalities in Patients with Ankylosing Spondylitis
  1. A. Godzenko1,
  2. Y.O. Korsakova2,
  3. A. Bochkova2,
  4. O. Rumyantseva2,
  5. V. Badokin1,
  6. S. Erdes2
  1. 1Russian medical academy of postgraduate education
  2. 2Nasonova research institute of rheumatology, Moscow, Russian Federation

Abstract

Background Aortic and valve abnormalities are systemic inflammatory manifestations of ankylosing spondylitis (AS). Data on the prevalence, clinical significance and evolution are discrepant.

Objectives To assess the dynamics of aortic and valve abnormalities detected by transthoracal echocardiography (TTE) in AS pts according to the results of prospective study.

Methods 45 pts with AS (The New-York criteria) age <60 years, with the initial TTE - changes of aorta and valves and without concomitant cardiac diseases were assessed at the Institute of Rheumathology from 2008 to 2015. At baseline 15 pts had aortic root dilatation, 21 – aortic wall thickening, 32 – aortic valve thickening, 15 – mitral valve thickening. 5 pts had valve prosthesis (including 2 with both aortic and mitral prosthesis). 19 pts had aortic regurgitation (AR), 15 of them – 1–2 degree, 4 – 3–4 degree), 20 pts had mitral regurgitation (MR) 1–2 degree. Subaortic thickening (“bump”) was detected in 10 pts. 16 of 45 pts used anti-TNF drugs during the observation period, 14 pts – only NSAID, 15 – NSAID and DMARD, including sulfaslazine (11 pts) and metotrexate (4 pts). All pts were underwent re-TTE after 1–4 years

Results Negative dynamics was detected in 27 (60%) pts in total. Progression of aortic root dilatation from 1 to 6mm was detected in 12 of 15 pts (80%), in 2 - dilatation was first identified. 14 pts had first identified valve thickening (9 – aortic, 4 – mitral, 1 – both). 5 pts were underwent valve replacement: 4 – aortic, 1 – mitral. AR progression was detected in 10 pts (in 2 – of 2 degree, in 8 – of 1 degree), MR progression – in 6 pts of 1 degree). A negative correlation was found between anti-TNF- therapy and progression of aortic root dilatation (R=-0,329, P=0,03). “Subaortic bump” was first identified in 3 pts. Among 10 pts with subaortic bump initially, decrease from 8mm to 3mm was found in 1 pts, complete regression – in 2, all used biologics.

Conclusions Aortic root and valve abnormalities tend to progression in most AS pts. Subaortic bump is able to regress if it is due to inflammatory edema and not fibrosis. Active anti-inflammatory therapy can protect in cardiac disease progression.

  1. Klingberg E, Sveälv BG, Täng MS, Bech-Hanssen O, Forsblad-d'Elia H, Bergfeldt L. Aortic Regurgitation Is Common in Ankylosing Spondylitis: Time for Routine Echocardiography Evaluation Am J Med. 2015 Nov;128(11):1244–1250.e1. doi: 10.1016/j.amjmed.2015.04.032. Epub 2015 Jun 4.

  2. van der Horst-Bruinsma IE, Nurmohamed MT. Management and evaluation of extra-articular manifestations in spondyloarthritis. Ther Adv Musculoskelet Dis. 2012 Dec;4(6):413–22. doi: 10.1177/1759720X12458372.

Disclosure of Interest None declared

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