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Doppler echocardiographic evidence of left ventricular diastolic dysfunction in ankylosing spondylitis

https://doi.org/10.1016/0002-9149(93)90551-MGet rights and content

Abstract

Although cardiac involvement in the form of conduction abnormalities or aortic regurgitation occurs in 5 to 10% of patients with ankylosing spondylitis, few studies have assessed left ventricular (LV) function. This study assesses the prevalence of both systolic and diastolic LV dysfunction and other cardiac abnormalities in patients with ankylosing spondylitis who have no clinical cardiac manifestations. Fifty-nine patients (49 men and 10 women, mean age 42 ± 10 years) underwent full clinical examination, electrocardiography, 24-hour Holter monitoring and 2-dimensional, M-mode and Doppler echocardiography. Mean disease duration was 17 ± 9 years (range 1 to 42). Seventeen patients had evidence of noncardiac extraarticular manifestations. Precordial examination was normal in all. An age- and sex-matched control group of 44 healthy subjects was also studied.

On echocardiography, abnormal LV diastolic function was detected in 12 patients (20%). Prolonged isovolumic relaxation time, prolonged deceleration time, reduced rate of descent of flow velocity in early diastole (EF slope) and reversal of the early and late peak transmitral diastolic flow velocities (EA ratio) were noted in 9 patients. In 3 patients there was an increased EA ratio, reduced deceleration time and increased EF slope. Mild aortic regurgitation and mitral regurgitation was seen in 1 and 3 patients, respectively. No abnormalities of left atrial size, LV systolic or diastolic dimensions or wall thicknesses were noted. There was no correlation between the presence of LV diastolic dysfunction and age, disease severity, disease duration, or the presence of extraarticular manifestations. It is concluded that LV diastolic dysfunction occurs frequently in patients with ankylosing spondylitis, even in the absence of clinical cardiac involvement.

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    Citation Excerpt :

    Previous studies have shown that left ventricular diastolic function was impaired in patients with AS who had no clinical evidence of cardiac involvement [26–28]. Crowley et al. [27] described a spectrum of LV diastolic filling abnormalities in 20% of patients with AS who had no clinical evidence of cardiac involvement using Doppler echocardiographic measurements of LV inflow. In 15% of patients there were changes of abnormal relaxation associated with prolonged IVRT, prolonged DT and a low E/A peak mitral flow velocity ratio.

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