title: Insights into cardiac involvement in ankylosing spondylitis from cardiovascular magnetic resonance.
abstract: To evaluate cardiac involvement in patients with ankylosing spondylitis using cardiac magnetic resonance (CMR).
  
  
  
  Patients with ankylosing spondylitis without cardiovascular symptoms or known cardiovascular disease were screened by transthoracic echocardiography (TTE) for participation in this exploratory CMR study. We prospectively enrolled 15 ankylosing spondylitis patients with an abnormal TTE for further tissue characterisation using late gadolinium enhancement (LGE) and T1 mapping. T1 mapping was used to calculate myocardial extracellular volume (ECV). Disease activity was assessed by C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) measurements.
  
  
  
  In the total of 15 included patients, 14 had a complete CMR exam (mean age 62 years, 93% male and mean disease duration 21 years). Left ventricular (LV) diastolic dysfunction was the most common finding on TTE (79%), followed by aortic root dilatation (14%), right ventricular (RV) dilatation (7%) and RV dysfunction (7%). CMR revealed focal hyperenhancement in three patients (21%), all with a particular pattern of enhancement. LV dysfunction, as defined by a LV ejection fraction below 55%, was observed in five patients (36%). Myocardial ECV was correlated with the CRP concentration (R=0.78, p<0.01) and ESR level (RS=0.73, p<0.01).
  
  
  
  In patients with ankylosing spondylitis, CMR with cine imaging and LGE identified global LV dysfunction and focal areas of hyperenhancement. Myocardial ECV, quantified by CMR T1 mapping, was associated with the degree of disease activity. These results may suggest the presence of cardiac involvement in ankylosing spondylitis and may show the potential of ECV as a marker for disease monitoring.
authors.affiliation: Departments of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.|Netherlands Heart Institute, Utrecht, The Netherlands.
authors.forename: P Stefan
authors.initials: PS
authors.lastname: Biesbroek
authors.affiliation: Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade Amsterdam, The Netherlands.|Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Sjoerd C
authors.initials: SC
authors.lastname: Heslinga
authors.affiliation: Departments of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Thelma C
authors.initials: TC
authors.lastname: Konings
authors.affiliation: Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Irene E
authors.initials: IE
authors.lastname: van der Horst-Bruinsma
authors.affiliation: Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Mark B M
authors.initials: MBM
authors.lastname: Hofman
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Peter M
authors.initials: PM
authors.lastname: van de Ven
authors.affiliation: Departments of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Otto
authors.initials: O
authors.lastname: Kamp
authors.affiliation: Departments of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Vokko P
authors.initials: VP
authors.lastname: van Halm
authors.affiliation: Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Mike J L
authors.initials: MJL
authors.lastname: Peters
authors.affiliation: Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Yvo M
authors.initials: YM
authors.lastname: Smulders
authors.affiliation: Departments of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Albert C
authors.initials: AC
authors.lastname: van Rossum
authors.affiliation: Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade Amsterdam, The Netherlands.
authors.forename: Mike T
authors.initials: MT
authors.lastname: Nurmohamed
authors.affiliation: Departments of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Robin
authors.initials: R
authors.lastname: Nijveldt
mesh_terms: D000368:Aged; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000150:complications* / Q000175:diagnosis; D016277:Ventricular Function, Left / Q000502:physiology