Echocardiographic Evidence of Cardiac Involvement in Ankylosing Spondylitis

Abstract

Aortic insufficiency, myocardial fibrosis and conduction disturbances are known complications of ankylosing spondylitis (AS). However, few studies have assessed left ventricular diastolic function and no data are available about P-wave analysis. In this study 88 AS patients and 31 healthy volunteers underwent clinical examination, electrocardiography, echocardiography and signal-averaged P-wave analysis for the evaluation of asymptomatic cardiac involvement. The aortic root in AS patients was larger and this was correlated with the duration of the disease. Five of 88 AS patients (5.7%) had evidence of mitral valve prolapse, six (6.8%) had thick and redundant mitral valves without prolapse, five (5.7%) had mild mitral regurgitation, two had moderate (2.3%) and two had mild (2.3%) aortic regurgitation. Examination of diastolic function revealed a lower peak of E-wave velocity (E) and E/A ratio, a higher peak of A-wave velocity (A) and acceleration rate of the A wave, a longer deceleration time of E-wave velocity and isovolumic relaxation time in the AS group compared to controls. Mean filtered P-wave duration (PWD) in AS was similar to that of controls. However, PWD in AS patients was positively correlated with left atrial dimension and acceleration rate of the A wave and negatively correlated with E and E/A ratio. In conclusion, cardiac involvement may be seen in AS patients in the absence of clinical manifestations. Echocardiographic examination of diastolic function can be used in this asymptomatic period. Further studies are needed to clarify the prognostic significance of diastolic abnormalities and the value of P-wave analysis in cardiac evaluation of these patients.

Assessment of left ventricular function by tissue Doppler imaging in patients with ankylosing spondylitis

“…In the two other studies, frequency of LV diastolic dysfunction in ASp patients was found to be 20% and 26% respectively. 11,12 The present study has showed that mitral E and A velocities, PEP, EP, PEP/EP, IVRT and MPI were not different between two groups. E/A ratio was decreased and DT was longer significantly in ASp patients than controls, and diastolic dysfunction was found as 26% similar to other studies using to conventional echocardiography.…”

“…4,8,11,12 Therefore, the aim of the present study was to analyse systolic and diastolic functions of the left ventricle by using tissue Doppler echocardiography and myocardial performance index (MPI) together with conventional methods.…”

Left ventricular systolic dysfunction in two patients with ankylosing spondylitis: What is the role of corticosteroids?

“…Systolic dysfunction may arise as a consequence of the aortic valve disease, but coexistence of dilated cardiomyopathy with AS has not been described. Although previous studies have demonstrated the presence of diastolic dysfunction in AS, Yildirir et al (2) found a significant diastolic dysfunction with an abnormal relaxation pattern in patients with AS. Gould et al (3) also revealed significant decreases in peak filling and time to peak filling during strenuous activity in patients with AS.…”

A New Cardiac Autonomic Function Predictor (Heart Rate Turbulence) in Patients with Ankylosing Spondylitis

“…In various studies, it has been shown that diastolic dysfunction and left ventricular hypertrophy were seen in patients with AS. Diastolic dysfunction in patients with AS was determined by echocardiography and histopathologic examination (6,7,26).…”

“…Cardiac and neurologic manifestations represent some of the extra-skeletal involvements of AS (1,2). Conduction system abnormalities (3,4), valvular diseases (5,6), diastolic dysfunction (7), and pulmonary hypertension (8) are some of the various cardiac manifestations. Although these cardiac involvements may be seen in patients with AS in the absence of clinical manifestations, cardiovascular death in patients with AS is higher than in the general population (9,10).…”