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Insights into cardiac involvement in ankylosing spondylitis from cardiovascular magnetic resonance
  1. P Stefan Biesbroek1,2,
  2. Sjoerd C Heslinga3,4,
  3. Thelma C Konings1,
  4. Irene E van der Horst-Bruinsma4,
  5. Mark B M Hofman5,
  6. Peter M van de Ven6,
  7. Otto Kamp1,
  8. Vokko P van Halm1,
  9. Mike J L Peters7,
  10. Yvo M Smulders7,
  11. Albert C van Rossum1,
  12. Mike T Nurmohamed3,
  13. Robin Nijveldt1
  1. 1Departments of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
  2. 2Netherlands Heart Institute, Utrecht, The Netherlands
  3. 3Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade Amsterdam, The Netherlands
  4. 4Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
  5. 5Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
  6. 6Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
  7. 7Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Dr Robin Nijveldt, Department of Cardiology, 5F, VU University Medical Center, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands; r.nijveldt{at}cardiologie-vumc.nl

Abstract

Objective To evaluate cardiac involvement in patients with ankylosing spondylitis using cardiac magnetic resonance (CMR).

Methods 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.

Results 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).

Conclusions 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.

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Footnotes

  • PSB and SCH contributed equally to this paper.

  • Contributors All authors made substantial contributions to the work, critically reviewed the manuscript for important intellectual content and gave approval for its final version to be published. Specifically, PSB, SCH, MJLP, YMS, MTN and RN made substantial contributions to the conception or design of the work. PSB and SCH wrote the manuscript. SCH recruited study participants from the outpatient clinic and collected disease characteristics. PSB scheduled patients for CMR and supervised the CMR exams. PSB and RN analysed CMR data. TCK and OK acquired and analysed echocardiographic data. PSB, SCH, PMvdV and RN interpreted the data.

  • Funding Dutch Arthritis Foundation (Reumafonds).

  • Competing interests None declared.

  • Ethics approval Ethics Committee of the Slotervaart Hospital and Reade, Amsterdam, The Netherlands.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent Obtained.

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