title: Assessment of serum asymmetric dimethylarginine levels and left ventricular diastolic function in patients with ankylosing spondylitis.
abstract: OBJECTIVE
  To assess left ventricular diastolic functions and serum dimethylarginine (ADMA) concentrations, as well as the effect of different treatment strategies on ADMA concentrations and diastolic function parameters, in patients with ankylosing spondylitis (AS).
  
  
  METHODS
  Sixty AS patients and 40 control subjects without classical cardiovascular (CV) risk factors were included in the study. Baseline clinical and echocardiographic variables were obtained. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and ADMA levels were measured. Spinal mobility, disease activity and functional status were assessed using Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index.
  
  
  RESULTS
  CRP, ESR and ADMA levels were significantly higher in the AS group as compared to the control group. Two (5%) control subjects and six (10%) AS patients met the criteria for left ventricular diastolic dysfunction (DD) on conventional Doppler echocardiography, but the difference was not statistically significant (P = 0.36). However, using tissue Doppler imaging, 12 (20%) patients in the AS group and three (8%) subjects in the control group were diagnosed with left ventricular DD (P = 0.08). The anti-tumor necrosis factor (TNF)-α group, conventional therapy group and control group were compared in terms of ADMA, CRP, ESR levels and echocardiographic parameters. ADMA levels were significantly lower in anti-TNF-α group as compared to the conventional therapy group (P < 0.001). In the control group, ADMA levels were significantly lower than both treatment groups (P < 0.001).
  
  
  CONCLUSIONS
  Increased ADMA levels reveal impaired nitric oxide metabolism in a relatively young group of patients with AS, who have no classical CV risk factors. Anti-TNF-α may have beneficial effect on endothelial function in AS patients by reducing ADMA levels.
authors.affiliation: Department of Cardiology, Dicle University School of Medicine, Diyarbakir, Turkey.
authors.forename: Umit
authors.initials: U
authors.lastname: Inci
authors.affiliation: Department of Cardiology, Dicle University School of Medicine, Diyarbakir, Turkey.
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Yildiz
authors.affiliation: Department of Physical Medicine and Rehabilitation, Dicle University School of Medicine, Diyarbakir, Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Batmaz
authors.affiliation: Department of Cardiology, Dicle University School of Medicine, Diyarbakir, Turkey.
authors.forename: Ebru
authors.initials: E
authors.lastname: Tekbas
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D001688:Biological Products / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003971:Diastole; D004185:Disability Evaluation; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D009569:Nitric Oxide / Q000378:metabolism; D013167:Spondylitis, Ankylosing / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000276:immunology; D016277:Ventricular Function, Left / Q000187:drug effects; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D015415:Biomarkers; D014409:Tumor Necrosis Factor-alpha; D009569:Nitric Oxide; C018524:N,N-dimethylarginine; D002097:C-Reactive Protein; D001120:Arginine
keywords: ankylosing spondylitis; anti-TNF-α; asymmetric dimethylarginine; diastolic function