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Bolaji O, Oriaifo O, Adabale O, Dilibe A, Kuruvada K, Ouedraogo F, Ezeh E, Nair A, Olanipekun T, Mazimba S, Alraies C. A meta-analysis of left ventricular dysfunction in ankylosing spondylitis. J Clin Hypertens (Greenwich) 2024; 26:772-788. [PMID: 38708932 PMCID: PMC11232451 DOI: 10.1111/jch.14827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/03/2024] [Accepted: 04/12/2024] [Indexed: 05/07/2024]
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory arthritis affecting the spine, presenting a considerable morbidity risk. Although evidence consistently indicates an elevated risk of ischemic heart disease among AS patients, debates persist regarding the likelihood of these patients developing left ventricular dysfunction (LVD). Our investigation aimed to determine whether individuals with AS face a greater risk of LVD compared to the general population. To accomplish this, we identified studies exploring LVD in AS patients across five major databases and Google Scholar. Initially, 431 studies were identified, of which 30 met the inclusion criteria, collectively involving 2933 participants. Results show that AS patients had: (1) poorer Ejection Fraction (EF) [mean difference (MD): -0.92% (95% CI: -1.25 to -0.59)], (2) impaired Early (E) and Late (atrial-A) ventricular filling velocity (E/A) ratio [MD: -0.10 m/s (95% CI: -0.13 to -0.08)], (3) prolonged deceleration time (DT) [MD: 12.30 ms (95% CI: 9.23-15.36)] and, (4) a longer mean isovolumetric relaxation time (IVRT) [MD: 8.14 ms (95% CI: 6.58-9.70)] compared to controls. Though AS patients show increased risks of both systolic and diastolic LVD, we found no significant differences were observed in systolic blood pressure [MD: 0.32 mmHg (95% Confidence Interval (CI): -2.09 to 2.73)] or diastolic blood pressure [MD: 0.30 mmHg (95% CI: -0.40 to 1.01)] compared to the general population. This study reinforces AS patients' susceptibility to LVD without a notable difference in HTN risk.
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Affiliation(s)
- Olayiwola Bolaji
- Department of Internal Medicine, Rutgers University New Jersey Medical School, Newark, New Jersey, USA
| | - Osejie Oriaifo
- Department of Internal Medicine, ECU Health Medical Center, Greenville, North Carolina, USA
| | - Olanrewaju Adabale
- Department of Internal Medicine, ECU Health Medical Center, Greenville, North Carolina, USA
| | - Arthur Dilibe
- Department of Internal Medicine, ECU Health Medical Center, Greenville, North Carolina, USA
| | - Krishna Kuruvada
- Department of Internal Medicine, University of Maryland Capital Region Health, Largo, Maryland, USA
| | - Faizal Ouedraogo
- Department of Internal Medicine, University of Maryland Capital Region Health, Largo, Maryland, USA
| | - Ebubechukwu Ezeh
- Department of Cardiovascular Disease, The University Of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ambica Nair
- Ocean Medical Center Brick, Brick, New Jersey, USA
| | - Titilope Olanipekun
- Brigham and Women's Hospital Department of Medicine Boston, Boston, Massachusetts, USA
| | - Sula Mazimba
- Advanced Heart Failure and Transplant Cardiology, AdventHealth Medical Group Transplant Institute, Orlando, Florida, USA
| | - Chadi Alraies
- Cardiovascular Institute, Detroit Medical Center, DMC Heart Hospital, Detroit, Michigan, USA
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Romand X, Adeline F, Dalecky M, Pflimlin A, Bellier A, Barone-Rochette G, Wendling D, Gaudin P, Claudepierre P, Dougados M, Baillet A. Systematic assessment of heart valves and cardiac function by echocardiography in axial spondyloarthritis: a systematic review and meta-analysis. Joint Bone Spine 2022; 89:105375. [DOI: 10.1016/j.jbspin.2022.105375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
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Park HS, Laiz A, Sanchez-Vega J, Díaz Del Campo P, Martín-Martínez MA, Guerra-Rodríguez M, Corominas H. Valve Abnormalities, Risk Factors for Heart Valve Disease and Valve Replacement Surgery in Spondyloarthritis. A Systematic Review of the Literature. Front Cardiovasc Med 2021; 8:719523. [PMID: 34631824 PMCID: PMC8498574 DOI: 10.3389/fcvm.2021.719523] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/17/2021] [Indexed: 12/14/2022] Open
Abstract
Objective: Evaluate the evidence on the abnormalities of the aortic root and heart valves, risk and prognostic factors for heart valve disease and valve replacement surgery in spondyloarthritis. Methods: A systematic literature review was performed using Medline, EMBASE and Cochrane databases until July 2021. Prevalence, incidence, risk and prognostic factors for heart valve disease; dimension, morphology, and pathological abnormalities of the valves were analyzed. Patient characteristics (younger age, history of cardiac disease or longer disease duration) and period of realization were considered for the analysis. The SIGN Approach was used for rating the quality of the evidence of the studies. Results: In total, 37 out of 555 studies were included. Overall, the level of evidence was low. The incidence of aortic insufficiency was 2.5–3.9‰. Hazard Ratio for aortic insufficiency was 1.8–2.0. Relative risk for aortic valve replacement surgery in ankylosing spondylitis patients was 1.22–1.46. Odds ratio for aortic insufficiency was 1.07 for age and 1.05 for disease duration. Mitral valve abnormalities described were mitral valve prolapse, calcification, and thickening. Aortic valve abnormalities described were calcification, thickening and an echocardiographic “subaortic bump.” Abnormalities of the aorta described were thickening of the wall and aortic root dilatation. The most common microscopic findings were scarring of the adventitia, lymphocytic infiltration, and intimal proliferation. Conclusions: A higher prevalence and risk of aortic valve disease is observed in patients with ankylosing spondylitis. Studies were heterogeneous and analysis was not adjusted by potential confounders. Most studies did not define accurate outcomes and may have detected small effects as being statistically significant.
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Affiliation(s)
- Hye-Sang Park
- Rheumatology Department, Hospital Dos de Maig, Barcelona, Spain
| | - Ana Laiz
- Rheumatology and Autoimmune Diseases Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Jesus Sanchez-Vega
- Cardiology Department, Hospital Universitari Bellvitge, Hospitalet de Llobregat, Spain.,Department of Medicine, Universitat de Barcelona (UB), Barcelona, Spain
| | | | | | | | - Hector Corominas
- Rheumatology Department, Hospital Dos de Maig, Barcelona, Spain.,Rheumatology and Autoimmune Diseases Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Min HK, Lee J, Ju JH, Kwok SK, Youn HJ, Park SH. Echocardiographic Evaluation of Axial Spondyloarthritis in Korea: Data From the Catholic Axial Spondyloarthritis Cohort. JOURNAL OF RHEUMATIC DISEASES 2020. [DOI: 10.4078/jrd.2020.27.1.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Hong Ki Min
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Jennifer Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hyeon Ju
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho-Joong Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kocabaş H, Öncel CR, küçük M, Belgi Yıldırım A, kaçar C. Ankilozan Spondilit Hastalarında Kırmızı Hücre Dağılım Genişliği Ve Subklinik Sol Ventrikül Disfonksiyonu. ACTA MEDICA ALANYA 2018. [DOI: 10.30565/medalanya.393936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Karaman K, Karayakali M, Erken E, Demirtaş A, Öztürk M, Altunkaş F, Arisoy A, Turan OE, Ceyhan K, Çelik A. Assessment of myocardial repolarisation parameters in patients with familial Mediterranean fever. Cardiovasc J Afr 2017; 28:154-158. [PMID: 28759086 PMCID: PMC5558142 DOI: 10.5830/cvja-2016-074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 07/10/2016] [Indexed: 01/13/2023] Open
Abstract
Background: Familial Mediterranean fever (FMF) is a chronic, recurrent auto-inflammatory disease characterised by self-terminating attacks of fever and sterile polyserositis. The main cause of death in auto-inflammatory diseasesis cardiovascular events. Additionally, auto-inflammatory diseases have potential effects on the myocardial repolarisation parameters, including the T-wave peak-to-end (Tp-Te) interval, cTp-Te interval (corrected Tp-Te) and the cTp-Te/ QT ratio. The aim of this study was to analyse the efficacy of myocardial repolarisation alterations in anticipation of cardiovascular risks in patients with FMF. Methods: This study included 66 patients with FMF and 58 healthy control subjects. Tp-Te and cTp-Te intervals and the cTp-Te/QT ratio were measured from the 12-lead electrocardiogram. Results: In electrocardiographic parameters, analysis of QT, QT dispersion, corrected QT (QTc) and QTc dispersion were similar between the groups. The Tp-Te and cTp-Te intervals and Tp-Te/QT and cTp-Te/QT ratios were significantly prolonged in FMF patients. Multivariate linear regression analyses indicated that erythrocyte sedimentation rate was an independent predictor of a prolonged cTp-Te interval. Conclusions: Our study revealed that when compared with control subjects, Tp-Te and cTp-Te intervals and cTp-Te/QT ratio were increased in FMF patients.
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Affiliation(s)
- Kayihan Karaman
- Department of Cardiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey.
| | - Metin Karayakali
- Department of Cardiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Ertuğrul Erken
- Department of Cardiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Ahmet Demirtaş
- Department of Cardiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Mustafa Öztürk
- Department of Cardiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Fatih Altunkaş
- Department of Cardiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Arif Arisoy
- Department of Cardiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Oğuzhan Ekrem Turan
- Department of Cardiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Köksal Ceyhan
- Department of Cardiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Ataç Çelik
- Department of Cardiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
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Heslinga SC, Van Dongen CJ, Konings TC, Peters MJ, Van der Horst-Bruinsma IE, Smulders YM, Nurmohamed MT. Diastolic left ventricular dysfunction in ankylosing spondylitis—A systematic review and meta-analysis. Semin Arthritis Rheum 2014; 44:14-9. [DOI: 10.1016/j.semarthrit.2014.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 02/03/2014] [Accepted: 02/07/2014] [Indexed: 01/08/2023]
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Paroxysmal Supraventricular Tachycardia and Wolff–Parkinson–White Syndrome in Ankylosing Spondylitis: A Large Cohort Observation Study and Literature Review. Semin Arthritis Rheum 2012; 42:246-53. [DOI: 10.1016/j.semarthrit.2012.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 04/10/2012] [Accepted: 04/19/2012] [Indexed: 11/18/2022]
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Okan T, Sari I, Akar S, Cece H, Goldeli O, Guneri S, Akkoc N. Ventricular diastolic function of ankylosing spondylitis patients by using conventional pulsed wave Doppler, myocardial performance index and tissue Doppler imaging. Echocardiography 2008; 25:47-56. [PMID: 18271873 DOI: 10.1111/j.1540-8175.2007.00541.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate ventricular functions by using standard Doppler echocardiography (SDE), myocardial performance index (MPI), and pulsed wave tissue Doppler imaging (PW-TDI) in patients with ankylosing spondylitis (AS) and healthy controls. METHODS Forty-nine AS patients (38 +/- 11 years, 25 M/24 F) and 33 controls (36 +/- 9 years, 17 M/16 F) were studied. Two-dimensional, M-Mode, SDE, PW-TDI echocardiography examinations were performed. Spinal mobility was assessed by the Bath ankylosing spondylitis metrology index (BASMI) measurement. Patients were also evaluated using the Bath ankylosing spondylitis functional index (BASFI) and the Bath ankylosing spondylitis disease activity index (BASDAI). RESULTS Four control subjects and six AS patients met the left ventricular (LV) diastolic dysfunction (DD) criteria by using conventional Doppler echocardiography (p > 0.05). However, using PW-TDI method 22 patients in the AS group and six subjects in the control group were diagnosed to have LV DD (Em/Am < 1). Pseudonormalized pattern was present in 16 AS patients and two control subjects. Correlation analysis revealed significant moderate negative correlations between Em/Am and BASMI, age and body mass index (p < 0.05; r =-0.3, -0.6, and -0.4, respectively). No correlation was observed between Em/Am and disease duration, BASFI, BASDAI, CRP, and ESR. We could not detect any right ventricular function involvement either by conventional or by recently introduced echocardiography methods. The risk of developing LV DD was found to be 3.7 times higher in AS patients. CONCLUSION When sensitive echocardiographic Doppler techniques such as MPI, TDI-derived MPI, and PW-TDI are utilized, DD can be detected in a significant proportion of patients with AS without cardiovascular (CV) disease which may contribute CV mortality in these patients.
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Affiliation(s)
- Taha Okan
- Department of Cardiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
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Vinsonneau U, Brondex A, Mansourati J, Saraux A, Cornily JC, Arlès F, Godon P, Quiniou G. Cardiovascular disease in patients with spondyloarthropathies. Joint Bone Spine 2008; 75:18-21. [PMID: 17913549 DOI: 10.1016/j.jbspin.2007.04.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Accepted: 04/03/2007] [Indexed: 11/19/2022]
Abstract
Spondyloarthropathies are associated with a greater cardiovascular risk than expected based on the cardiac lesions known to occur in these diseases. The prevalence of several conventional risk factors is high in spondyloarthropathy patients, and chronic inflammation also contributes to premature plaque formation. In addition, susceptibility genes for spondyloarthropathies may be associated with an increased risk of cardiovascular disease. Finally, several drugs used to treat spondyloarthropathies may contribute to the occurrence of cardiovascular events. A careful evaluation of the cardiovascular risk profile is a key component of the management of patients with spondyloarthropathies.
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Affiliation(s)
- Ulric Vinsonneau
- Cardiology Department, Clermont Tonnerre Armed Forces Teaching Hospital, BP 41, 29240 Brest Armées, France.
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Peters MJ, van der Horst-Bruinsma IE, Dijkmans BA, Nurmohamed MT. Cardiovascular risk profile of patients with spondylarthropathies, particularly ankylosing spondylitis and psoriatic arthritis. Semin Arthritis Rheum 2004; 34:585-92. [PMID: 15609262 DOI: 10.1016/j.semarthrit.2004.07.010] [Citation(s) in RCA: 251] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the cardiovascular risk profile of spondylarthropathy patients, particularly ankylosing spondylitis and psoriatic arthritis. METHODS A Pubmed literature search was performed to collect English-language articles for this clinically orientated review. Studies were selected if they included (cardiovascular) mortality and morbidity and/or data about cardiovascular risk factors in spondylarthropathies. RESULTS Ankylosing spondylitis as well as psoriatic arthritis appear to be associated with an increased cardiovascular mortality and morbidity. Several factors, ie, smoking, altered lipid profile, hypertension, increased fibrinogen level, enhanced number of platelets, and hypercoagulability might explain the enhanced cardiovascular risk. Moreover, a decline in physical activity, the presence of HLA-B27, and inflammation may play a role. Finally, undertreatment of cardiovascular morbidity also may contribute to the higher cardiovascular risk. CONCLUSIONS The available data indicate an increased cardiovascular risk in spondylarthropathy patients, particularly those with ankylosing spondylitis and psoriatic arthritis. RELEVANCE Rheumatologists should be aware of the enhanced cardiovascular risk in patients with ankylosing spondylitis and psoriatic arthritis. If modifiable cardiovascular risk factors are identified, treatment could ultimately result in a lower cardiovascular morbidity and mortality.
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Affiliation(s)
- Mike J Peters
- Department of Rheumatology, VU University Medical Centre, Jan van Breemen Institute, Slotervaart Hospital, Amsterdam, The Netherlands
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Jiménez-Balderas FJ, García-Rubi D, Pérez-Hinojosa S, Arellano J, Yáñez P, Sanchez ML, Camargo-Coronel A, Zonana-Nacach A. Two-dimensional echo Doppler findings in juvenile and adult onset ankylosing spondylitis with long-term disease. Angiology 2001; 52:543-8. [PMID: 11512693 DOI: 10.1177/000331970105200806] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors' objective was to determine by 2-dimensional echo Doppler (2DECHO) the cardiac abnormalities in juvenile onset ankylosing spondylitis (JOAS) and adult onset ankylosing spondylitis (AOAS) in male patients with long-term disease. Twenty patients with JOAS, 31 with AOAS, and 20 healthy controls of the same age and gender without cardiopulmonary symptoms were studied. Using 2DECHO, the heart dimensions were determined according to American Society of Echocardiography guidelines. The left ventricle ejection fraction (LVEF) was calculated by Teichholz's formula. Cardiomyopathy was established when 2DECHO had diminished LVEF. Statistics used were the Student t and Fisher test, chi2, and ANOVA. Ninety percent of JOAS and 51% of AOAS patients were B27+ (p=0.005). The disease duration was 19.3 +/- 8.8 years in JOAS and 14.8 +/- 12.8 years in AOAS (p=NS). Age at the time of the study was 30.7 +/- 9.9 years in JOAS vs 40.3 +/- 12.7 in AOAS (p=0.003), and vs 40.2 +/- 17 years in controls (p=NS). There was a higher frequency of cardiomyopathy in AOAS (32.2%) than in JOAS (25%) and the controls (0%) (p=0.01). Patients with JOAS had a higher mitral valve gradient (25%) than AOAS patients (19%, p=NS) and controls (0%, p=0.04). Abnormal aortic ring reflectance was shown in 19% of AOAS vs 0% abnormalities in JOAS and controls (p=0.01). The aortic root diameter was increased in 58% of AOAS, 30% of JOAS, and 0% of controls (p=0.001). The frequency of 2DECHO abnormalities was increased in cardiopulmonary asymptomatic spondylitis patients. Despite the high frequency of B27+, JOAS had a lower frequency of aortic abnormalities than AOAS. Mitral valve gradient was found in JOAS and in AOAS that could contribute to a decreased ejection fraction and to left ventricular dysfunction.
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