title: Aortic Regurgitation Is Common in Ankylosing Spondylitis: Time for Routine Echocardiography Evaluation?
abstract: OBJECTIVE
  The aim of this study was to assess the prevalence of aortic regurgitation and any relation to disease activity and specific human leukocyte antigen (HLA)-B27 subtypes in patients with ankylosing spondylitis.
  
  
  METHODS
  Transthoracic echocardiography was performed in 187 patients (105 men), mean age (SD) 50 (13) years, and mean disease duration 24 (13) years, and was related to demographic, clinical, radiographic, electrocardiographic, and laboratory data.
  
  
  RESULTS
  Aortic regurgitation was found in 34 patients (18%; 95% confidence interval [CI], 12%-24%): mild in 24, moderate in 9, and severe in one. The prevalence was significantly higher than expected from population data. Conduction system abnormalities were documented in 25 patients (13%; 95% CI, 8%-18%), and significantly more likely in the presence of aortic regurgitation (P = .005), which was related to increasing age and longstanding disease, and increased from ~20% in the 50s to 55% in the 70s. It was also independently associated with disease duration, with higher modified Stoke Ankylosing Spondylitis Spine Score, and with a history of anterior uveitis. HLA-B27 was present in similar proportions in the presence vs absence of aortic regurgitation. For comparison, clinically significant coronary artery disease was present in 9 patients (5%; 95% CI, 2%-8%).
  
  
  CONCLUSIONS
  Patients with ankylosing spondylitis frequently have cardiac abnormalities, but they more often consist of disease-related aortic regurgitation or conduction system abnormalities than manifestations of atherosclerotic heart disease. Because aortic regurgitation or conduction abnormalities might cause insidious symptoms not easily interpreted as of cardiac origin, we suggest that both electrocardiography and echocardiography evaluation should be part of the routine management of patients with ankylosing spondylitis.
authors.affiliation: Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Klingberg
authors.affiliation: Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
authors.forename: Bente Grüner
authors.initials: BG
authors.lastname: Sveälv
authors.affiliation: Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
authors.forename: Margareta Scharin
authors.initials: MS
authors.lastname: Täng
authors.affiliation: Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
authors.forename: Odd
authors.initials: O
authors.lastname: Bech-Hanssen
authors.affiliation: Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
authors.forename: Helena
authors.initials: H
authors.lastname: Forsblad-d'Elia
authors.affiliation: Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden. Electronic address: lennart.bergfeldt@hjl.gu.se.
authors.forename: Lennart
authors.initials: L
authors.lastname: Bergfeldt
mesh_terms: D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D015796:HLA-B27 Antigen / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D013167:Spondylitis, Ankylosing / Q000097:blood / Q000150:complications* / Q000276:immunology
chemical_list: D015415:Biomarkers; D015796:HLA-B27 Antigen
keywords: Ankylosing spondylitis; Aortic regurgitation; Disease activity; Echocardiography; Electrocardiography