Background Ankylosing spondylitis (AS) is associated with concomitant cardiac pathology, such as diastolic left ventricular (LV) dysfunction (1), valvular dysfunction, and aortic disease (2), all presumably caused by inflammation. The precise prevalence of diastolic left ventricular (LV) dysfunction and the effects of anti-inflammatory treatment thereon are currently unknown.
Objectives To investigate the prevalence of diastolic LV dysfunction compared to controls and the effects of tumor necrosis factor (TNF) -α blocking therapy on ventricular function in AS patients.
Methods Forty consecutive AS patients were included and treated for one year with TNF-α blocking therapy. Transthoracic echocardiography was performed at baseline and at one year. Forty age and gender matched asymptomatic random controls were included from an established echocardiographic cohort. Diastolic LV function (normal, dysfunction grade I, II, or III) and systolic LV function (ejection fraction, EF) were assessed. Valvular and aortic pathology was documented. Disease activity was measured with C-reactive protein (CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score–CRP (ASDAS).
Results At baseline, diastolic LV dysfunction (all grades) was present in nine patients (23%) vs one (3%) control (p=0.011). Systolic LV dysfunction was present in 0 (0%) patients vs one (3%) control (p=0.625). In total, 13 (33%) AS patients and six (15%) controls (p=0.066) had some form of cardiac pathology (i.e. one or more of the following: diastolic and/or systolic LV dysfunction, aortic valve dysfunction, aortic dilatation; one AS patient and one control had two disorders).
Treatment with TNF-α blocking therapy had no effect on systolic LV function, but diastolic LV dysfunction (n=3 grade I, n=1 grade II) improved to normal in four patients (p=0.125), and neither worsened nor developed in the other patients. After the start of TNF-α blocking therapy CRP decreased from 4.0 (1.3–12.0) mg/l to 2.0 (1.9–3.2) mg/l (p<0.001), BASDAI decreased from 5.2±1.6 to 3.7±2.0 (p=0.001) and ASDAS decreased from 3.1±1.2 to 2.0±1.0 (p<0.001).
Conclusions AS patients had a significantly increased prevalence of diastolic LV dysfunction compared to controls which improved during treatment with TNF-α blocking therapy. This appears to be related to the anti-inflammatory effects of TNF-blocking therapy.
Heslinga SC, Van Dongen CJ, Konings TC, Peters MJ, van der Horst-Bruinsma IE, Smulders YM, et al. Diastolic left ventricular dysfunction in ankylosing spondylitis–a systematic review and meta-analysis. Semin Arthritis Rheum 2014 Aug;44(1):14–9.
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.
Acknowledgement This is an investigator initiated study partially supported by an unrestricted grant from MSD, The Netherlands
Disclosure of Interest None declared
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