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CLINICAL STUDIES

Aortic root disease and valve disease associated with ankylosing spondylitis

^a Division of Cardiology, Veterans Affairs Medical Center, and University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA

Manuscript received January 30, 1998; revised manuscript received June 29, 1998, accepted July 17, 1998.

Address for correspondence: Dr. Carlos A. Roldan, Cardiology Division 5B-111, Veterans Affairs Medical Center, 2100 Ridgecrest Drive SE, Albuquerque, New Mexico 87108
Roldan.Carlos_A{at}Albuquerque.VA.Gov

Objectives. This study sought to determine the prevalence, characteristics, relation to clinical features and evolution of aortic root disease and valve disease associated with ankylosing spondylitis (AKS).

Background. Aortic root disease and valve disease are common in patients with AKS, but their clinical and prognostic implications have not been well defined.

Methods. Forty-four outpatients with AKS and 30 age- and gender-matched healthy volunteers underwent initial transesophageal echocardiography and rheumatologic evaluations. Twenty-five patients underwent clinical and echocardiographic follow-up 39 ± 10 months later.

Results. Aortic root disease and valve disease were common in patients (82%) as compared with controls (27%; p < 0.001). Aortic root thickening, increased stiffness and dilatation were seen in 61%, 61% and 25% of patients, respectively. Valve thickening (41% for the aortic and 34% for the mitral valve) manifested predominantly (74%) as nodularities of the aortic cusps and basal thickening of the anterior mitral leaflet, forming the characteristic subaortic bump. Valve regurgitation was seen in almost half of patients, and 40% had moderate lesions. Except for the duration of AKS, aortic root disease and valve disease were unrelated to the activity, severity or therapy of AKS. During follow-up of 25 patients, in up to 24% new aortic root or valve abnormalities developed, in 12% existing valve regurgitation worsened significantly and in 20% abnormalities resolved. Twenty percent of patients developed heart failure, underwent valve replacement, had a stroke or died, as compared with 3% of control subjects.

Conclusions. Aortic root disease and valve disease are common in patients with AKS, are unrelated to clinical features of AKS, can resolve or progress over time and are associated with clinically important cardiovascular morbidity.

Abbreviations and Acronyms   AKS = ankylosing spondylitis   TEE = transesophageal echocardiography

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