Ankylosing Spondylitis and Cardiac Abnormalities

There are a number of systemic diseases with cardiovascular manifestations in which echocardiography plays a valuable role for surveillance and follow-up of anticipated cardiovascular abnormalities. Systemic autoimmune disorders are frequently associated to cardiac involvement such as pericarditis, myocardi-tis, valvular abnormalities or ischemic coronary disease. Ankylosing spondylitis (AS) is also a chronic systemic in-flammatory rheumatic disorder that primarily affects the axial joints and mainly involves young male. Extra-articular manifestations vary widely in terms of both frequency and severity. The most common extra-articular manifestations are uveitis, bowel disease, skin, lung and kidney involvement; less frequently cardiovascular involvement occurs. 1) Screening for extra -articular manifestations in patients with AS is important for appropriate management as the presence of extra-articular manifestations may be a consequence of uncontrolled systemic inflammation and may influence treatment decisions. 2) The prevalence of cardiac pathologies in patients with AS has been reported to be 10% to 30%. It is related to a sclerosing in-flammatory process that primarily involves the aortic root and the aortic valve, and the chronic inflammation may extend into the ventricular septum, atrioventricular node, proximal bundle of His and bundle branches or fascicles. Thus, various studies indicate a higher rate of conduction disturbances, val-vular heart disease and ascending aortic involvement in patients with AS compared with the normal population. 4) In this issue of the journal, Park et al. 5) reported the early valvular and aortic involvement in young male patients with AS using transesophageal echocardiography. A total of 70 AS patients were divided into AS group I (< 10 years of disease duration) and AS group II (≥ 10 years) depending on their disease duration after the first diagnosis. The thickness of aortic valve was increased in AS patients than in control (control vs. root diameter at the sinus of Valsalva was slightly increased in AS group II. Furthermore, aortic strain and distensibility were decreased and aortic stiffness beta index was increased in AS group II compared with control and AS group I. Mitral annu-lus early diastolic velocity (E') and systolic velocity (S') by tissue Doppler imaging were slightly decreased in AS group II. However there was no increased rate for valvular regurgitation (aortic and mitral valve) and for conduction disturbances. There are some limitations in this study. As they described, the design of this study was observational and cross-sectional, and conducted in a single center. The clinical significance of the results is unclear in …