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Aortic root diameter is associated with HLA-B27: identifying the patient with ankylosing spondylitis at risk for

M Baniaamam1,2, S C Heslinga3, T C Konings4

  • 1Amsterdam Rheumatology and Immunology Center, Reade Rheumatology, Jan van Breemenstraat 2, 1056 AB, Amsterdam, The Netherlands. m.baniaamam@reade.nl.

Rheumatology International
|November 3, 2021
PubMed

Insights

Elderly male patients with ankylosing spondylitis (AS) who are HLA-B27 positive show a larger aortic root diameter compared to their HLA-B27 negative counterparts. This finding suggests potential cardiovascular monitoring needs for this specific patient group.

Area of Science:

  • Cardiovascular Medicine
  • Rheumatology
  • Genetics

Background:

  • Ankylosing spondylitis (AS) is a chronic inflammatory disease primarily affecting the axial skeleton.
  • The human leukocyte antigen B27 (HLA-B27) gene is strongly associated with AS, influencing disease presentation and progression.
  • Cardiovascular complications, including aortic root dilation, are recognized in AS patients.

Purpose of the Study:

  • To investigate the association between HLA-B27 status and aortic root diameter in elderly ankylosing spondylitis patients.
  • To compare aortic root dimensions and the prevalence of aortic valve regurgitation (AVR) between HLA-B27 positive and negative AS patients.
  • To identify specific subgroups within the AS population that may benefit from targeted cardiovascular screening.

Main Methods:

  • A cross-sectional study of 193 elderly AS patients (50-75 years) from the CARDAS cohort was conducted.
  • Cardiovascular screening included echocardiography to measure the aortic root diameter at the sinuses of Valsalva during diastole.
  • Aortic root diameter was indexed to body surface area (BSA), and regression analysis was used to assess associations with HLA-B27 status, adjusting for covariates.

Main Results:

  • The aortic root index was significantly higher in HLA-B27 positive AS patients (1.76 cm/m²) compared to HLA-B27 negative patients (1.64 cm/m²; p < 0.001).
  • Regression analysis confirmed a significant association between HLA-B27 positivity and increased aortic root index (β 0.091, p = 0.02), even after adjusting for age, sex, and cardiovascular risk factors.
  • Elderly male HLA-B27 positive AS patients exhibited a significantly increased aortic root index compared to HLA-B27 negative males (p < 0.001). No difference in AVR prevalence was observed between groups.

Conclusions:

  • Elderly HLA-B27 positive AS patients, particularly males, have a larger aortic root diameter compared to HLA-B27 negative AS patients.
  • While AVR prevalence did not differ, the increased aortic root index suggests a potential risk for aortic complications.
  • Consideration of echocardiographic monitoring for aortic root dimensions in elderly male HLA-B27 positive AS patients may be warranted due to the progressive nature of AVR.

Keywords:
Ankylosing spondylitisAortic root diameterCardiovascular diseaseHLA-B27 genotypeTransthoracic echocardiography

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