title: Impaired coronary microvascular and left ventricular diastolic functions in patients with ankylosing spondylitis.
abstract: BACKGROUND
  It has been shown that the patients with inflammatory rheumatic diseases such as systemic lupus erythematosus and rheumatoid arthritis have an increased risk of developing atherosclerosis. However, the association of ankylosing spondylitis (AS) to atherosclerosis and related diseases is still controversial. Accordingly, we investigated coronary flow reserve (CFR) and left ventricular (LV) diastolic function in patients with AS using transthoracic Doppler echocardiography.
  
  
  METHODS
  CFR and LV diastolic function were studied in 40 patients with AS (38.9+/-10.2 years, 26 males) and 35 healthy volunteers (37.5+/-6.4 years, 23 males). Coronary diastolic peak flow velocities (DPFV) were measured at baseline and after dipyridamole infusion. CFR was calculated as the ratio of hyperemic to baseline DPFV. LV diastolic function was assessed by both standard and tissue Doppler imaging.
  
  
  RESULTS
  Demographic features and coronary risk factors except diastolic blood pressure were similar between the groups. CFR were significantly lower in the AS group than in the control group (2.20+/-0.46 versus 3.02+/-1.50, P<0.0001). Reflecting LV diastolic function mitral A-wave and E/A ratio were borderline significant, and mitral E-wave deceleration time and isovolumic relaxation time were significantly different between the groups. Serum hsCRP and TNF-alpha levels were significantly higher in the patients with AS, and hsCRP and TNF-alpha levels independently correlated with CFR.
  
  
  CONCLUSIONS
  These findings show that CFR reflecting coronary microvascular function and LV diastolic function are impaired in patients with AS, and severity of these impairments correlate well with hsCRP and TNF-alpha. These results suggest that impaired CFR may be an early manifestation of cardiac involvement in patients with AS.
authors.affiliation: Baskent University, Faculty of Medicine, Cardiology Department, Ankara, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Caliskan
authors.affiliation: Baskent University, Faculty of Medicine, Cardiology Department, Ankara, Turkey. Electronic address: aydoganer@yahoo.com.
authors.forename: Dogan
authors.initials: D
authors.lastname: Erdogan
authors.affiliation: Baskent University, Faculty of Medicine, Cardiology Department, Ankara, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Gullu
authors.affiliation: Baskent University, Faculty of Medicine, Rheumatology Department, Ankara, Turkey.
authors.forename: Sema
authors.initials: S
authors.lastname: Yilmaz
authors.affiliation: Baskent University, Faculty of Medicine, Cardiology Department, Ankara, Turkey.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Gursoy
authors.affiliation: Baskent University, Faculty of Medicine, Cardiology Department, Ankara, Turkey.
authors.forename: Aylin
authors.initials: A
authors.lastname: Yildirir
authors.affiliation: Baskent University, Faculty of Medicine, Rheumatology Department, Ankara, Turkey.
authors.forename: Eftal
authors.initials: E
authors.lastname: Yucel
authors.affiliation: Baskent University, Faculty of Medicine, Cardiology Department, Ankara, Turkey.
authors.forename: Haldun
authors.initials: H
authors.lastname: Muderrisoglu
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003326:Coronary Circulation; D003971:Diastole / Q000502:physiology*; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013167:Spondylitis, Ankylosing / Q000150:complications / Q000503:physiopathology*; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016277:Ventricular Function, Left