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Echocardiographic evidence of cardiac involvement in ankylosing spondylitis
A Yildirir1, S Aksoyek, M Calguneri
1Baskent University, Ankara, Turkey. ayliny@ato.org.tr
Insights
Ankylosing spondylitis (AS) patients show asymptomatic cardiac involvement, particularly diastolic dysfunction, detectable via echocardiography. P-wave analysis may offer further insights into cardiac health in AS.
Area of Science:
- Cardiology
- Rheumatology
- Internal Medicine
Background:
- Ankylosing spondylitis (AS) is linked to cardiac complications like aortic insufficiency and myocardial fibrosis.
- Left ventricular diastolic function and P-wave analysis in AS remain understudied.
- Early detection of cardiac involvement in asymptomatic AS patients is crucial.
Purpose of the Study:
- To evaluate asymptomatic cardiac involvement in ankylosing spondylitis (AS) patients.
- To assess left ventricular diastolic function and P-wave characteristics in AS.
- To correlate cardiac findings with disease duration and clinical parameters.
Main Methods:
- 88 AS patients and 31 healthy controls underwent clinical examination, ECG, echocardiography, and signal-averaged P-wave analysis.
- Echocardiography assessed aortic root, mitral valve, aortic regurgitation, and diastolic function parameters (E/A ratio, deceleration time, isovolumic relaxation time).
- P-wave duration (PWD) was analyzed and correlated with cardiac parameters and disease duration.
Main Results:
- AS patients exhibited larger aortic roots, correlated with disease duration.
- Abnormalities included mitral valve prolapse (5.7%), thick mitral valves (6.8%), and mild/moderate mitral and aortic regurgitation.
- AS patients showed impaired diastolic function: lower E-wave velocity and E/A ratio, higher A-wave velocity, and prolonged relaxation times.
- PWD in AS was similar to controls but correlated with left atrial dimension and diastolic function parameters.
Conclusions:
- Cardiac involvement, including diastolic dysfunction, is present in AS patients even without symptoms.
- Echocardiography, particularly diastolic function assessment, is valuable for detecting early cardiac changes in AS.
- Further research is needed to determine the prognostic value of diastolic abnormalities and P-wave analysis in AS cardiac evaluation.
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.