Ventricular diastolic dysfunction in ankylosing spondylitis patients without clinical evidence of cardiovascular disease

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Abstract

Objective

The aim of this study was to evaluate the prevalence and risk factors of ventricular diastolic dysfunction (LVDD) in ankylosing spondylitis (AS) patients without clinically evident cardiovascular disease in Sharkia governorate.

Methods

Forty-five AS patients without clinically evident cardiovascular disease were included in the present study. The control group included 20 apparently healthy volunteers. Bath ankylosing spondylitis metrology index (BASMI), Bath ankylosing spondylitis functional index (BASFI), and Bath ankylosing spondylitis disease activity index (BASDAI) were assessed in all patients. ECG and pulsed wave tissue Doppler imaging was performed for all patients.

Results

LVDD was detected in 19 (42%) patients compared with two (10%) controls. The Em/Am ratio was significantly decreased in patients. LVDD grade 1 was detected in 12 patients compared with two controls. Grade 2 LVDD was detected in five patients and grade 3 LVDD was detected in two patients compared with no controls. Univariate analysis revealed a significant risk for juvenile disease onset, increased disease duration, increased tumor necrosis factor (TNF)-α, or an increased total score for any of the following indices: BASMI, BASFI, or BASDAI. The odds ratio and 95% confidence interval were 2 (1.9–3.2), 2.7 (1.6–3.3), 2.4 (1.4–3.3), 2.1 (1.9–3.2), 3.2 (2.4–6.3), and 2.3 (1.2–3.2), respectively. According to multiple logistic regression analysis, the most significant risk factors were increased TNF-α, increased BASMI, and juvenile disease onset. P-values were less than 0.001, less than 0.01, and less than 0.05, respectively.

Conclusion

Risk for LVDD in AS patients is four-fold that in healthy controls. The most significant risk factor was increased TNF-α.

Recommendation

Pulsed wave tissue Doppler imaging should be performed routinely in AS patients for earlier detection and therapy of LVDD.

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