Aortic regurgitation in ankylosing spondylitis-an echocardiography follow-up study

To investigate the long-term course of aortic regurgitation (AR) and the width of the proximal ascending aorta (PAA) in patients with ankylosing spondylitis (AS).

This is a follow-up cohort study of patients with AS examined with echocardiography at inclusion (2009 to 2011). Out of the initial 187, a subgroup of 52 patients (54% men, mean age 62 years) was selected for follow-up based on presence/absence of AR at baseline; 26 with AR (18 mild, 7 moderate, 1 severe) and 26 age/sex-matched without AR. These patients were re-examined with echocardiography in 2014 by an independent observer. Severity of AR and PAA diameter were assessed. Related samples Wilcoxon signed rank and Mann-Whitney U tests were used to analyze the change (Δ) in PAA diameter.

Regarding the 26 patients with AR at baseline, two had an aggravated grade, 16 an unchanged grade, and eight a less severe AR versus baseline. Two of the 26 patients with no AR at baseline had a mild grade of AR at follow-up. The mean (SD) ΔPAA diameter was 0 (3) mm, and no statistically significant ΔPAA diameter was found overall or in analyses stratified by sex and baseline presence of AR.

Most patients with AS had an unchanged grade of AR and PAA diameter at follow-up 3 to 5 years after the initial echocardiography. These findings suggest that the average progress of AR in patients with AS is slow and that progression of PAA dilatation seems rare. Key points • Aortic regurgitation (AR) is not uncommon in patients with ankylosing spondylitis (AS) and caused by aortic root dilatation and/or cusp fibrosis/retraction, but little is known about its course. • According to this repeated echocardiography study in median 4.3 years after the baseline evaluation, the majority of patients had no progress of AR or increase in the proximal ascending aorta diameter. • AR in AS is rarely rapidly progressive.