1. Cardiac manifestations in patients with Ankylosing Spondylitis
Dr.Enida Xhaferi1, Asc. Prof.Teuta Backa Cico2, Dr. Artur Zoto2,Dr. Fatbardha Lamaj3
1 University of Medicine/Faculty of Medical Technical Sciences, Tirana, Albania
2 University Hospital Center “Mother Theresa” , Rheumatology Clinic, Tirana, Albania
3 Intermedica Laboratory, Tirana, Albania
CONCLUSIONS
Their mean heart rate was 67 beats/min. 41 patients had sinus rhythm, one patient had atrial fibrillation, three patients had mild sinus tachycardia (>100 beats per minute) and two patients had mild sinus bradycardia (<60 beats per minute).
INTRODUCTION
Ankylosing spondylitis is a chronic and inflammatory condition, affecting the spine, sacroiliac, and peripheral joints. This entity most often affects young men and may lead to spinal vertebral fusion. Human leukocyte antigen (HLA)-B27 is present in the majority of patients with AS and is reported to contribute to the pathophysiologic manifestations of this condition.The disease usually begins in the second or third decade; male to female prevalence is between 2:1 and 3:1. Axial involvement and spinal symptoms are the predominant features of the AS patient. Extra articular manifestations include eye disease, neurologic involvement, pulmonary disease and cardiac manifestations. Heart disease is a well recognized complication of ankylosing spondylitis, Various studies indicate a higher rate of conduction disturbances, valvular heart diseases, aortitis and cardiomyopathies i patients with AS when compared with the normal population.The aim of this study is to review occurrence of cardiac manifestations in patients suffering from Ankylosing Spondylitis and to draw conclusions about future patient management.
PATIENTS AND METHODS
This is a cross sectional study conducted with 42 patients diagnosed with Ankylosing spondylitis in accordance with modified New York criteria. All recruited patients underwent physical examination by a trained rheumatologist. They completed Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) questionnaire and their Erythrocyte sedimentation rate, C-reactive protein level, haemoglobin level, white blood cell count, and platelet count were recorded. Patients echocardiographic and electrocardiographic examination was conducted by a trained cardiologist. First-degree heart block was defined as prolongation of the PR (PQ) interval >200 ms on ECG, Right bundle branch block (RBBB) diagnosis was based on the presence of QRS > 120 ms, delayed intrinsicoid deflection > 0.03 in right precordial leads (V1- V2), and typical R,S and T wave changes in ECG leads, left anterior hemiblock was defined as leftward deviation of the QRS axis between -30 to -90 degrees and the presence of the characteristic ECG patterns. Echocardiographic examination was applied for diagnosis of valvular diseases, In order to avoid confounding, 3 patients diagnosed with mitral valve disease were excluded form the analysis because of rheumatic fever antecedents. Skewness and curtosis of all data was checked and they were all normally distributed. t-test was used to examine differences between group means for normal variables, Mann-Whitney U rank test was used for examination of not normally distributed data. Chi square test was used for categorical variables. Pearson and Spearman correlation analysis was used to asses relationships. Means and standard deviations were displayed for quantitative variables and frequencies were reported for qualitative variables. Statistical analysis was carried out with IBM SPSS version 20.
2 patients were diagnosed with aortic regurgitation, 2 patients with mitral valve regurgitation (one with aortic + mitral valve disease, one with mitral regurgitation), first degree AV block was observed in no patient when conservative (PQ interval >220ms) diagnostic criteria were used and patients had first degree AV block with PQ>200ms criteria. There was no case of RBBB or LBBB (complete or incomplete), two patients had LAFB and no patient had RBBB+LAFB.
Exact Fisher Test showed that there is a statistically significant difference between males and females with cardiac disorders p =0.026 and involvement is more prominent in males.
Discussion
Aortic root and valve disease are common occurrence in patients with Ankylosing spondylitis, some of the changes associated with this disorder are: aortic root thickening and dilatation, aortic cusp thickening and retraction, subaortic bump and aortic and mitral regurgitation.
Conduction disorders are common in AS patients. The most frequent disorders are: first-degree atrioventricular block, right bundle branch block and left anterior hemiblock. Complete heart block has been found in 1-9% of the patients.
Conclusion
Conclusion
RESULTS
The most common observed disorders are valvular disorders (aortic, mitral and tricuspid insufficiency) and conduction disturbances (left anterior hemiblock, right bundle branch block, sinus bradycardia, and atrial fibrillation). Patients with AS should be screened with echocardiography and electrocardiography.
There were 42 patients in this group (n=42), 38 men and 4 women, with a gender ratio of 9.5. Patients’ mean age was 44±10, (68-21). Table no.1 contains demographic data from the group. Patients had BASDAI score > 4 and were currently being treated for the disease with NSAID-s and DMARD-s.