Early Cardiac Valvular Changes in Ankylosing Spondylitis: A Transesophageal Echocardiography Study

Abstract

BackgroundThis study was conducted to determine the early cardiac valvular changes in young male ankylosing spondylitis (AS) patients.MethodsA total of 70 AS patients on treatment without clinical cardiac symptoms were divided into group I (< 10 years, n = 50) and group II (≥ 10 years, n = 20) depending on their disease duration after first diagnosis. Twenty-five healthy volunteers were selected as control subjects. All the subjects underwent transthoracic and transesophageal echocardiography, electrocardiography, and rheumatologic evaluation for AS patients.ResultsThe thickness of both the aortic and mitral valve was more increased in AS patients than in controls. Aortic valve thickness over 1.3 mm could predict AS with a sensitivity of 73% and specificity of 76%. The prevalence of aortic valve thickening was higher in the AS group compared to the controls. The prevalence of aortic and mitral regurgitation was very low and there was no difference between the controls and the patients. The aortic valve thickening was related to longer disease duration, high blood pressure, disease activity and inflammatory markers.ConclusionThickening of the aortic and mitral valve was observed without regurgitation in male AS patients early in the course of their disease without clinical cardiac manifestations. This subclinical change of aorto-mitral valve in early AS should be considered and followed up to determine its prognostic implication and evolution.

Echocardiography in the Assessment of Patients with Rheumatologic Diseases

“…Valve thickening may be detected in 41 % of the aortic valve and 34 % of the mitral valve, predominantly as nodularities of the aortic cusps and basal thickening of the anterior mitral leaflet forming the characteristic subaortic bump [22,67]. Valve disease in patients with AS can be classified into three categories:…”

“…(1) aortic regurgitation secondary to proximal aortitis leading to aortic root thickening, stiffness, dilatation and, rarely, aneurysm formation; (2) aortic regurgitation resulting from aortic valvulitis causing cusp thickening and retraction; and (3) mitral regurgitation due to thickening of the aortomitral junction (subaortic bump) causing retraction and decreased mobility of the anterior mitral leaflet and incomplete leaflet coaptation [22,67]. Early in the course of the disease, only thickening of the aortic and mitral valve leaflets is observed without regurgitation or clinical cardiac manifestations [67].…”

“…Early in the course of the disease, only thickening of the aortic and mitral valve leaflets is observed without regurgitation or clinical cardiac manifestations [67]. Upon long-term follow-up, aortic root or valve abnormalities may develop or progress, although resolution has been reported in some patients [22].…”

The Frequency and Severity of Extraskeletal Manifestations of Ankylosing Spondylitis

“…Появились публи-кации, подтверждающие не только частое вовлечение структур сердца в патологический процесс при АС, но и возможность раннего поражения клапанов и корня аорты, прогрессирования этих изменений, необходимости протезирования клапанов и имплантации ЭКС у части больных [28,39].…”

Progression of Aortic and Valvular Heart Diseases in Patients With Ankylosing Spondylitis

“…С такой же частотой диагностировали АР Е. Klingberg и соавт. [10], предлагая выполнять электрокар-диографию (ЭКГ) и ЭхоКГ всем больным АС в качестве рутинного обследования, а корейские авторы [11] даже на ранней стадии болезни у пациентов с АС достоверно чаще, в сравнении с контрольной группой, выявляли утолщение створок АК и МК.…”