Heart damage in ankylosing spondylitis
https://doi.org/10.14412/1995-4484-2009-1144
Abstract
Objective. To study heart damage in pts with ankylosing spondylitis (AS) by ECG and echocardiography (EchoCG). Material and methods. 344 pts with definite AS not older than 60 years without comorbid cardiac diseases examined in the Institute of rheumatology during 2005-2008 were included. ECG with 12 leads was performed in all pts and transthoracic EchoCG – in 101 pts. Results. Rhythm and conductivity disturbances were revealed in 67 from 344 (19,5%) pts: atrioventricular (a/v) heart block was present in 20 (5,8%) pts (16 had 1, 2 – 2 and 3 – 3 stage of a/v heart block). 27 (7,8%) pts had intraventricular heart block. EchoCG signs of aortal valve changes were revealed in 45 from 101 (44,5%) pts: thickness or dilatation of aorta – in 36 (35,6%), aortal valve cusps thickness – in 32 (31,7%), mitral – in 15 (14,8%). Local thickness in the form of a comb beneath aortal valve on the back wall of aorta basis at the site of its junction with basis of mitral anterior cusp – “subaortic bump” was found in 10 (10%) pts. Frequency of a/v heart block among pts with changes of aorta and cardiac valves was significantly higher than in pts without such changes. On the other hand frequency of aorta and cardiac valves changes in pts with a/v heart block was significantly higher than in pts without a/v heart block (p=0,0027) what shows relationship between conductivity disturbances and aorta and cardiac valves damage in AS. Conclusion. Cardiac pathology in AS is characterized by frequent (44,5%) damage of aorta basis and aorta-mitral junction zone in combination with thickness of aortal and mitral valves and conductivity disturbances.
References
1. <div><p>Mallory TB. Case records of the Massachusetts General Hospital. N Engl J Med., 1936, 214, 690-8</p><p>Gupta BK, Panwar RB, Kabra PK. Ankylosing spondylitis in association with mitral stenosis, mitral regurgitation, and aortic regurgitation: a case report and review of the literature. Echocardiography, 2003, 20(3), 275-7</p><p>Huffer LL, Furgerson JL. Aortic Root Dilatation with sinus of Valsalva and coronary artery aneurysms associated with Ankylosing spondylitis. Tex. Heart Inst. J., 200, 33(1), 70-3</p><p>Lautermann D, Braun J. Ankylosing spondylitis - cardiac manifestations. Clin. Exp. Rheumatol., 2002, 20, 6 (suppl 28), 511-15</p><p>Lee SG, Im HY, Schueller WC. HLA-B27 positive juvenile arthritis with cardiac involvement preceding sacroiliac joint changes. Heart, 2001, 86(6), E19</p><p>Roldan CA, Chavez J, Wiest PW. Aortic root disease associated with ankylosing spondylitis. J. Am. Col. Cardiol., 1998,32, 5, 1397-404</p><p>Bergfeldt L, Edhag O, Vallin H. Cardiac conduction disturbances, an underestimated manifestation in ankylosing spondylitis. A 25-year follow-up study of patients. Acta Med. Scand., 1982, 212, 217-23</p><p>Bergfeldt L, Edhag O, Vedin L, Vallin H. Ankylosing spondylitis: an important cause of severe disturbances of the cardiac conduction system. Prevalence among pacemaker-treated men. Am. J. Med., 1982, 73, 187-91</p><p>Котельникова Г. П., Камова Н. Н., Полянская И. П. Характер сердечной патологии при анкилозирующем спондилоартрите (болезни Бехтерева). Тер. архив, 1993, 65, 5, 34-7</p><p>Brunner F, Kunz A, Weber U. Ankylosing spondylitis and heart abnormalities: do cardiac conduction disorders, valve regurgitation and diastolic dysfunction occure more often in male patients with diagnosed ankylosing spondylitis for over 15 years than in the normal population? Clin. Rheumatol., 2006, 25(1), 24-9</p><p>Bergfeldt L. HLA-B27-associated Cardiac Disease. Ann Intern. Med., 1997, 127, 1, 621-9</p><p>Laitinen O, Leirisalo M, Skylv G. Relation between HLA-B27 and clinical features in patients with Yersinia arthritis. Arthritis Rheum., 1977, 20, 1121-4</p><p>Bruges-Armas J, Lima C, Simas Lopes C. HLA-B27 in patients with a permanent pacemaker. Ann. Rheum. Dis., 2003, 62, 1018</p><p>Bulkley BH, Roberts WC. Ankylosing spondylitis and aortic regurgitation. Description of the characteristic 9 cardiovascular lesion from study of eight necropsy patients. Circulation, 1973, 48, 1014-27</p><p>Kochbati S, Ben Miled M, BoussemaF. Cardiac involvement in spondyloarthropathies. Tunis Med., 2004, 82 (12), 1082-90</p><p>Van der Linden S., Valkenburg H., Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis: a proposal to modification of the New York criteria. Arthritis Rheum., 1984, 27, 361-8</p><p>Кушаковский М. С. Аритмии сердца (расстройства сердечного ритма и проводимости). Причины, механизмы, электрокардиографическая и электрофизиологическая диагностика, клиника, лечение. Руководство для врачей. Санкт-Петербург, ООО издательство «Фолиант», 1999, изд 2, 443- 72, 475-90</p><p>Фейгенбаум Х. Эхокардиография. Пер. с англ. под ред. Митькова В. В. М. Видар, 1999, 491</p><p>BernsteinL and BrochOL. Cardiac complications in spondyloarthritis ankylopoietica. Acta Med. Scand., 1949, 135, 185-94</p><p>Пронин С. В., Анохин В. Н., Чеканов В. С. Поражение сердца и аорты при анкилозирующем спондилоартрите. Ревматология, 1988, 2, 34-9</p><p>Бадокин В. В., Г. П. Котельникова. Поражение сердца у больных псориатическим артритом. Тер. архив, 2004, 5, 56-61</p><p>Krarup N, Poulsen S, Baandrup U. Aorto- mitral inflammation in rheumatological disease: transoesophageal echocardiographic presentation. Eur. J. Echocardiography, 2007, 8, (5), 346-51</p><p>Heeneman S, Daemen J. Cardiovascular risk in spondyloarthritides. Curr. Opin. Rheumatol., 2007, 19, 358-62</p></div><br />
Review
For citations:
Godzenko A.A., Bochkova A.G., Korsakova Y.O., Bunchuk N.V., Mach E.S. Heart damage in ankylosing spondylitis. Rheumatology Science and Practice. 2009;47(4):4-10. (In Russ.) https://doi.org/10.14412/1995-4484-2009-1144
Views:
2957
Email this article 