J Cardiovasc Ultrasound.  2012 Mar;20(1):30-36. 10.4250/jcu.2012.20.1.30.

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

• Park SH
• Sohn IS
• Joe BH
• Hwang HJ
• Park CB
• Jin ES
• Cho JM
• Kim CJ
• Bae JH
• Lee SH

• KMID: 2177338
• DOI: http://doi.org/10.4250/jcu.2012.20.1.30

Abstract

BACKGROUND
This study was conducted to determine the early cardiac valvular changes in young male ankylosing spondylitis (AS) patients.
METHODS
A total of 70 AS patients on treatment without clinical cardiac symptoms were divided into group I (< 10 years, n = 50) and group II (> or = 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.
RESULTS
The 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.
CONCLUSION
Thickening 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.

Keyword

Ankylosing spondylitis; Cardiac valves; Echocardiography

MeSH Terms

Aortic Valve
Echocardiography
Echocardiography, Transesophageal
Electrocardiography
Heart Valves
Humans
Hypertension
Male
Mitral Valve
Mitral Valve Insufficiency
Prevalence
Sensitivity and Specificity
Spondylitis, Ankylosing

Figure

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  Fig. 1 Transesophageal echocardiographic view of the aortic root showing how to measure the aortic root diameter at the annulus (label A), sinus of Valsalva (label B), and sino-tubular junction (label C), aortic valve thickness (white arrow head), and mitral valve thickness (white arrow).

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  Fig. 2 Receiver operating characteristics curve analysis showing aortic valve thickness over 1.3 mm predicts ankylosing spondylitis with a sensitivity of 73%, specificity of 76%, and area under the curve (AUC) of 0.8.

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