Kardiyovasküler Risk Faktörü Olmayan Ankilozan Spondilit Hastalarında Kardiyak Fonksiyonel Değişikliklerin Araştırılması

Öz

Giriş: Bu çalışmada amacımız eş zamanlı kardiyovasküler risk faktörü olmayan ankilozan spondilit hastalarında kardiyak fonksiyonel değişiklikleri araştırmaktır. Hastalar ve Yöntem: Çalışma popülasyonu kardiyovasküler risk faktörü olmayan sıralı 37 ankilozan spondilit hastasından (yaş: 41.4 ± 11.1; 28 erkek) oluşturuldu. Tüm hastaların 12 derivasyonlu elektrokardiyografi leri (EKG) çekildi ve tüm hastalara detaylı transtorasik ekokardiyografi k çalışma yapıldı. 12 derivasyonlu EKG'lerden QRS süresi, p dalga dispersiyonu ve düzeltilmiş QT dispersiyonu değerleri hesaplandı. Ekokardiyografi k çalışmada sol ventrikül sistolik ve diyastolik fonksiyonlarını yansıtan veriler elde edildi. Hastaların verileri yaş ve cinsiyet açısından benzer 28 sağlıklı bireyin (yaş: 40.1 ± 10.5; 19 erkek) verileri ile karşılaştırıldı. Bulgular: Hasta ve kontrol grupları arasında QRS süreleri, p dalga dispersiyonu ve düzeltilmiş QT dispersiyonu değerleri arasında anlamlı farklılık saptanmadı. Hasta ve kontrol gruplarının sol ventrikül sistolik ve diyastolik fonksiyonlarını yansıtan ekokardiyografi k parametrelerinin de benzer olduğu görüldü. Doku Doppler ile elde edilen mitral ve triküspid anülüs hızlarında da anlamlı farklılık saptanmadı. Ankilozan spondilit grubunda 2 (%5.4) hastada ve kontrol grubunda 2 (%7.2) bireyde minimal aort yetmezliği olduğu izlendi (p= 0.51). Sonuç: Kardiyovasküler risk faktörü olmayan ankilozan spondilit hastaları kullanılarak yapılan çalışmamızda, ankilozan spondilit hastalarının elektrokardiyografi k ve ekokardiyografi k bulgularının kontrol grubu ile benzer olduğu görüldü. Ankilozan spondilit hastalarındaki kardiyovasküler patoloji prevalansı hakkındaki çelişkili literatür verilerine eş zamanlı bulunan kardiyovasküler risk faktörlerinin katkısı olabileceği düşünüldü.

Anahtar Kelimeler

• Spondilit, ankilozan; aritmiler, kalp; ekokardiyografi; elektrokardiyografi

Assessment of Cardiac Functional Alterations of Ankylosing Spondylitis Patients without Cardiovascular Risk Factors

Öz

Introduction: The aim of this study is to evaluate cardiac functional alterations of ankylosing spondylitis patients without any cardiovascular risk factors. Patients and Methods: Thirty seven consecutive akylosing spondylitis patients without any cardiovascular risk factors constituted our study patient population (age: 41.4 ± 11.1 years, 28 male). Electrocardiographs (ECG) of all patients were obtained and all patients underwent comprehensive transthoracic echocardiographic examination. QRS durations, p wave dispersion and corrected QT dispersion (QTcd) values were calculated from 12-lead ECG's. Data refl ecting left ventricular systolic and diastolic functions were obtained from echocardiographic examinations. Data of patients were compared with the data of 28 age-and gender matched healthy control subjects (age: 40.1 ± 10.5 years, 19 male). Results: There were no signifi cant differences between patients and controls regarding QRS durations, p wave dispersion and QTcd values. There were also no signifi cant differences between patients and controls regarding parameters refl ecting left ventricular systolic and diastolic functions. Annular velocities at mitral and tricuspid annulus levels evaluated with pulsed-wave tissue Doppler imaging were also similar as well. Two (7.2%) subjects in the control group and 2 (5.4%) patients in the akylosing spondylitis group had minimal aortic regurgitation (p= 0.51). Conclusion: We could not demonstrate any electrocardiographic or echocardiographic evidence of structural myocardial alterations in a small sample of akylosing spondylitis patients free of cardiovascular risk factors. Effects of frequently encountered co-existent cardiovascular risk factors of ankylosing spondylitis patients might have contributed to the confl icting literature data related with this topic.

Anahtar Kelimeler

• Spondylitis, ankylosing; arrhythmias, cardiac; echocardiography; electrocardiography

Kaynakça

1. Khan MA. Update on spondyloarthropathies. Ann Intern Med 2002;136:896-907.
2. Luckie M, Irion L, Khattar RS. Severe mitral and aortic regurgita- tion in association with ankylosing spondylitis. Echocardiography 2009;26:705-710.
3. Roldan CA, Chavez J, Wiest PW, Qualls CR, Crawford MH. Aortic root disease and valve disease associated with ankylosing spon- dylitis. J Am Coll Cardiol 1998;32:1397-404.
4. Bulkley BH, Roberts WC. Ankylosing spondylitis and aortic regur- gitation. Description of the characteristic cardiovascular lesion from study of eight necropsy patients. Circulation 1973;48:1014- 27.
5. Palazzi C, Salvarani C, D’Angelo S, Olivieri I. Aortitis and periaor- titis in ankylosing spondyltis. Joint Bone Spine 2011:78;451-5.
6. Brewerton DA, Gibson DG, Goddard DH, Jones TJ, Moore RB, Pease CT, et al. The myocardium in ankylosing spondylitis. Lancet 1987;1:995-8.
7. Momeni M, Taylor N, Tehrani M. Cardiopulmonary manifestations of ankylosing spondylitis. Int J Rheumatol 2011;2011:728471.
8. Kazmierczak J, Peregud-Pogorzelska M, Biernawska J, Przepi- era-Bedzak H, Goracy J, Brzosko I, et al. Cardiac arrhythmias and conduction disturbances in patients with ankylosing spondylitis. Angiology 2008;58:751-6.

9. Brunner F, Kunz A, Weber U, Kissling R. Ankylosing spondylitis and heart abnormalities: do cardiac conduction disorders, valve regurgitation and diastolic dysfunction occur more often in male patients with diagnosed ankylosing spondylitis for over 15 years than in the normal population? Clin Rheumatol 2005;25:24-9.
10. Gunes Y, Tuncer M, Guntekin U, Sahin M, Yazmalar L. Effects of ankylosing spondylitis on the heart. Acta Cardiol 2009;64:385-92.
11. Sorajja D, Gami AS, Somers VK, Behrenbeck TR, Garcia-Toucha- rd A, Lopez-Jimenez F. Independent association between obstruc- tive sleep apnea and subclinical coronary artery disease. Chest 2008;133:927-33.
12. Kim SH, Cho GY, Baik I, Lim SY, Choi CU, Lim HE, et al. Asso- ciation of coronary artery calcifi cation with obstructive sleep ap- nea and obesity in middle-aged men. Nutr Metab Cardiovasc Dis 2010;20:575-82.
13. Kepez A, Harmanci A, Hazirolan T, Isildak M, Kocabas U, Ates A, et al. Evaluation of subclinical coronary atherosclerosis in mild asymptomatic primary hyperparathyroidism patients. Int J Cardio- vasc Imaging 2009;25:187-93.
14. Gottdiener JS, Bednarz J, Devereux R, Gardin J, Klein A, Manning WJ, et al. American Society of Echocardiography. American Soci- ety of Echocardiography recommendations for use of echocardi- ography in clinical trials. J Am Soc Echocardiogr 2004;17:1086- 119.
15. O’Neill TW, King G, Graham IM, Molony J, Bresnihan B. Echo- cardiographic abnormalities in ankylosing spondylitis. Ann Rheum Dis 1992;51:652-4.
16. Alves MG, Espirito-Santo J, Queiroz MV, Madeira H, Macieira- Coelho E. Cardiac alterations in ankylosing spondylitis. Angiology 1988;39:567-71.
17. LaBresh KA, Lally EV, Sharma SC, Ho G. Two-dimensional echo- cardiographic detection of preclinical aortic root abnormalities in rheumatoid variant diseases. Am J Med 1985;78:908-12.
18. Tucker CR, Fowles RE, Calin A, Popp RL. Aortitis in ankylosing spondylitis.Early detection of aortic root abnormalities with two- dimensional echocardiography. Am J Cardiol 1982;49:680-6.
19. Thomas D, Hill W, Geddes R, Sheppard M, Arnold J, Fritzsche J, et al. Early detection of aortic dilatation in ankylosing spondylitis using echocardiography. Aust N Z J Med 1982;12:10-3.
20. Roman MJ, Salmon JE. Cardiovascular manifestations of rheuma- tologic diseases. Circulation 2007;116:2346-55.
21. Van de Loo A, Arendts W, Hohnloser S. Variability of QT disper- sion measurements in the surface electrocardiogram in patients with acute myocardial infarction and in normal subjects. Am J Car- diol 1994;74:1113-8.
22. Moreno F, Villanueva T, Karagounis L, Anderson JL. Reduction of QT interval dispersion by successful thrombolytic therapy in acute myocardial infarction. TEAM-2 Study Investigators. Circula- tion1994;90:94-100.
23. Stoletniy LN, Pai SM, Platt ML, Torres VI, Pai RG. QT dispersion as a non-invasive predictor of inducible ventricular tachycardia. J Electrocardiol 1999;32:173-7.
24. Yildirir A, Aksoyek S, Calguneri M, Aytemir K, Kabakci G, Ovunc K, et al. QT dispersion as a predictor of arrhythmic events in patients with ankylosing spondylitis. Rheumatology 2000;39:875-9.
25. Acar G, Sayarlioglu M, Akcay A, Sokmen A, Sokmen G, Altun B, et al. Assessment of atrial electromechanical coupling character- istics in patients with ankylosing spondylitis. Echocardiography 2009;26:549-57.
26. Ozer N, Kepez A, Kaya B, Kilic H, Deniz A, Arslan U, et al. De- termination of left ventricular fi lling pressure by new echocardio- graphic methods in patients with coronary artery disease. Int J Cardiovasc Imaging 2008;24:141-7.
27. Bergfeldt L, Insulander P, Lindblom D, Möller E, Edhag O. HLA- B27: an important genetic risk factor for lone aortic regurgita- tion and severe conduction system abnormalities. Am J Med 1988;85:12-8.
28. Tolat A, Krishnan S, Lippman N, Dell’Orfano J, Berns E. Advanced heart block and atrial fl utter in a patient with HLA B27 spondyloar- thropathy. Europace 2010;12: 903-4.