title: Transthoracic and transesophageal echocardiographic evaluation of the aortic root and subvalvular structures in ankylosing spondylitis.
abstract: OBJECTIVE
  During the preclinical phase of cardiac involvement in ankylosing spondylitis (AS), examination, electrocardiography, and transthoracic echocardiography (TTE) may lack the sensitivity to detect cardiac abnormalities. Since transesophageal echocardiography (TEE) allows a closer view of the aortic root and subvalvular structures we investigated whether preclinical abnormalities of the aortic root and subvalvular structures could be detected.
  
  
  METHODS
  Clinical and echocardiographic (TTE and TEE) evaluation of 29 male patients with AS and 13 age matched controls.
  
  
  RESULTS
  No patient with AS had a high degree heart block. Aortic root dimensions were comparable between the study groups, but the anterior aortic wall was thinner in patients with AS than controls, 0.25 and 0.41 cm, respectively (p = 0.016). The posterior aortic wall was thicker and subjectively more echogenic than the anterior wall in 17/29 patients with AS compared to 4/13 controls. Aortic valve insufficiency was detected with TEE in 10/29 patients with AS. In 8/9 patients with AS studied with TEE, the subaortic structures were thickened and/or of increased echogenicity. This abnormal echo extended into the membranous septum.
  
  
  CONCLUSIONS
  Abnormal subvalvular echoes consistent with fibrosis of the aortic root and membranous interventricular septum were detected with TEE but not TTE. The use of TEE may allow earlier diagnosis of cardiac involvement in AS.
authors.affiliation: Department of Medicine, William S. Middleton Memorial Veterans Hospital and University of Wisconsin Hospital and Clinics, Madison, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Arnason
authors.forename: A K
authors.initials: AK
authors.lastname: Patel
authors.forename: P S
authors.initials: PS
authors.lastname: Rahko
authors.forename: W R
authors.initials: WR
authors.lastname: Sundstrom
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging*; D001021:Aortic Valve / Q000000981:diagnostic imaging*; D003710:Demography; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D013167:Spondylitis, Ankylosing / Q000175:diagnosis* / Q000000981:diagnostic imaging