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Echocardiographic abnormalities in ankylosing spondylitis
T W O'Neill1, G King, I M Graham
1Department of Rheumatology, St Vincents Hospital, Dublin, Ireland.
Insights
Ankylosing spondylitis patients show significant cardiac issues, including aortic incompetence, detected early by Doppler echocardiography. This highlights the need for cardiac screening in long-term ankylosing spondylitis (AS) management.
Area of Science:
- Cardiology
- Rheumatology
- Medical Imaging
Background:
- Ankylosing spondylitis (AS) is a chronic inflammatory disease primarily affecting the axial skeleton.
- Cardiac involvement in AS, particularly aortic valve disease, can be a serious complication.
- Early detection of cardiac abnormalities is crucial for managing AS patients.
Purpose of the Study:
- To assess the prevalence of cardiac disease in patients with long-standing ankylosing spondylitis.
- To investigate the utility of Doppler echocardiography in detecting subclinical cardiac abnormalities in AS.
- To identify clinical factors associated with cardiac involvement in AS.
Main Methods:
- Twenty-four patients with AS (disease duration ≥10 years) underwent cardiac assessment.
- Cardiac evaluation included clinical examination, electrocardiography, and Doppler echocardiography.
- A control group matched for age and sex was used for comparison.
Main Results:
- Seven patients (29%) exhibited evidence of cardiac disease.
- Findings included pericardial effusion, conduction abnormalities, and aortic incompetence.
- Doppler echocardiography detected clinically silent aortic incompetence and a novel finding of posterior aortic wall thickening in one AS patient.
- Patients with cardiac abnormalities were older, had longer disease duration, and more peripheral joint disease.
Conclusions:
- Cardiac disease is prevalent in patients with long-term ankylosing spondylitis.
- Doppler echocardiography is effective in identifying early-stage cardiac involvement, including subclinical aortic valve disease.
- Age, disease duration, and peripheral joint involvement may be associated with increased cardiac risk in AS.
Abstract:
Twenty four patients with ankylosing spondylitis of 10 or more years' duration were assessed for evidence of cardiac disease. Seven patients (29%) had evidence of cardiac disease, including one patient with a pericardial effusion, three with conduction abnormalities, and two with aortic incompetence. Aortic incompetence in one patient was clinically silent and was detected only with Doppler echocardiography. This patient had, in addition, thickening of the posterior aortic wall, an echocardiographic feature not previously described in ankylosing spondylitis. There was no evidence of aortic valve disease in a control group matched for age and sex. Patients with ankylosing spondylitis and cardiac abnormalities were older, had a longer disease duration, and more peripheral joint disease than those without cardiac abnormalities. Doppler echocardiography is a useful technique in the assessment of cardiac disease in ankylosing spondylitis and may detect aortic valve disease at an early preclinical stage.