Elevated Risk for Aortic Valve Regurgitation in Ankylosing Spondylitis

Patients with ankylosing spondylitis (AS) were found to be at an elevated risk of developing aortic valve (AV) regurgitation, according to study results presented at the European League Against Rheumatism (EULAR) 2020 E-Congress, held online from June 3 to 6, 2020.  

In this cross-sectional cohort study, 193 patients with AS (72% men; median age, 60±7 years) and 70 patients with osteoarthritis (OA; control group) were enrolled from a rheumatology outpatient clinic in Amsterdam, the Netherlands.

Patients received echocardiography, and data were assessed for disease activity and function with the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the Ankylosing Spondylitis Disease Activity Score with CRP (ASDAS-CRP). The prevalence rates of AV regurgitation were compared between patients with AS and OA. Logistic regression analyses were used to assess the risk for AV regurgitation across diagnostic groups.

Mean scores for disease activity were 3.1 (range, 1.6-5.0) for BASDAI, 2.1±1.0 for ASDAS-CRP, and 3.5 (range, 1.7-5.7) for BASFI, indicating moderate disease activity.

History of cardiovascular disease was comparable between the AS and control groups. Hypertensive medication use was more prevalent among patients with AS vs OA (44% vs 27%, respectively; P =.02). Results showed that 43% of patients with AS received anti-tumor necrosis factor treatment. Compared with control individuals, patients with AS had a greater prevalence of AV regurgitation (22% vs 10%, respectively; P =.04). The majority of AV regurgitation cases were mild in severity, although 1 moderate and 1 severe case was observed in the AS group. Mitral valve regurgitation occurred with similar frequency in the AS and OA groups (36% vs 33%, respectively; P =.59). In analyses adjusted for age, sex, and cardiovascular risk factors, patients with AS had elevated risk for AV compared with control individuals (odds ratio [OR], 2.8; 95% CI, 1.1-7.2; P =.038).

“This study demonstrates an almost tripled risk for developing AV regurgitation in Dutch patients [with] AS,” concluded the researchers. “Although mostly mild in this age, due to the progressive nature of AV regurgitation in AS, echocardiographic screening should be considered in elderly patients [with] AS.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Baniaamam M, Heslinga SC, Handoko ML, et al. Ankylosing spondylitis patients at risk of developing aortic valve regurgitation, need for mandatory echocardiography? Presented at: EULAR 2020 E-Congress; June 3-6, 2020. Abstract FRI0308.