Assessment of Serum ADMA Levels and Aortic Elastic Properties in Patients with Ankylosing Spondylitis

Yıl 2013, Cilt: 16 Sayı: 2, 127 - 132, 01.02.2012

Hasan Kaya Ebru Öntürk Tekbaş Faruk Ertaş Ümit İnci Mustafa Oylumlu Murat Yüksel Mesut Aydın İbrahim Batmaz Hatice Yüksel Mehmet Sıddık Ülgen

https://doi.org/10.5578/kkd.5212

Öz

Introduction: Ankylosing spondylitis is a chronic infl ammatory disease which may be associated with cardiovascular complications. The aim of the study was to investigate aortic elastic properties and serum asymetric dimethylarginine (ADMA) levels in patients with ankylosing spondylitis without any cardiac involvement. Patients and Methods: Fifty-fi ve ankylosing spondylitis patients and 30 age/gender matched healthy subjects were enrolled into this study. Fasting glucose, serum lipids, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and ADMA were studied. Aortic strain, distensibility and stiffness index were calculated from aortic diameters measured by transthoracic echocardiography and simultaneous blood pressure measurements. Results: ESR and CRP were higher in patients group. Serum ADMA levels were also higher in ankylosing spondylitis than in controls (0.76 ± 0.19 vs. 0.55 ± 0.12, p< 0.001). In subgroup analysis, ADMA was signifi cantly lower in anti-TNF-alfa treatment group than conventional treatment group (0.68 ± 0.15 vs. 0.87 ± 0.18, p< 0.001). Mean aortic strain and distensibility were lower and stiffness index was higher in ankylosing spondylitis group than controls. No correlation between ADMA and aortic elastic properties was observed. In ankylosing spondylitis group, a negative signifi cant correlation was found between duration of ankylosing spondylitis and aortic strain and distensibility. Conclusion: Our study suggest that patients with ankylosing spondylitis without cardiac involvement, aortic elasticity was impaired and ADMA levels were increased, while there was no signifi cant correlation between aortic elastic properties and ADMA levels.

Anahtar Kelimeler

Spondylitis, ankylosing; dimethylarginine; echocardiography; aorta; elastic modulus

Ankilozan Spondilit Hastalarında Serum ADMA Düzeyleri ve Aortun Elastik Özelliklerinin Değerlendirilmesi

Öz

Giriş: Ankilozan spondilit kronik infl amatuvar bir hastalık olup, kardiyovasküler komplikasyonlarla ilişkili olabilmektedir. Bu çalışmada amacımız, kardiyak tutulum olmayan ankilozan spondilit hastalarında aortun elastik özellikleri ile serum asimetrik dimetilarjinin (ADMA) düzeylerinin araştırılmasıdır. Hastalar ve Yöntem: Elli beş ankilozan spondilit hastasıyla benzer yaş ve cinsiyette 30 sağlıklı birey çalışmaya alındı. Açlık glukoz, serum lipidleri, C-reaktif protein (CRP), eritrosit sedimentasyon hızı (ESH) ve ADMA düzeyleri çalışıldı. Aortik strain, distensibilite ve sertlik indeksi transtorasik ekokardiyografi de aort çapı ölçümleri ve eş zamanlı kan basıncı ölçümleriyle hesaplandı. Bulgular: Ankilozan spondilit grubunda ESH ve CRP düzeyleri yüksekti. Serum ADMA düzeyleri ankilozan spondilit grubunda kontrol grubuna göre anlamlı olarak yüksekti (0.76 ± 0.19 ve 0.55 ± 0.12, p< 0.001). Alt grup analizinde, anti-TNF-alfa tedavisi alan grupta konvansiyonel tedavi grubuna göre daha düşük ADMA düzeyi ölçüldü (0.68 ± 0.15 ve 0.87 ± 0.18, p< 0.001). Ortalama aortik strain ve distensibilite değerleri ankilozan spondilit grubunda daha düşük iken, sertlik indeksi daha yüksek saptandı. Korelasyon analizinde ADMA düzeyleri ile aortun elastik özellikleri arasında ilişki izlenmezken, ankilozan spondilit grubunda hastalık süresi ile aortik strain ve distensibilite arasında ters yönde anlamlı korelasyon izlendi. Sonuç: Çalışmamızda elde ettiğimiz sonuçlar kardiyak tutulumun olmadığı ankilozan spondilit hastalarında aortik elastisitenin bozulduğunu ve ADMA düzeylerinin arttığını göstermektedir. Ayrıca, aortun elastik özellikleri ile ADMA düzeyleri arasında anlamlı ilişki saptanamamıştır.

Anahtar Kelimeler

Spondilit, ankilozan; dimetilarjinin; ekokardiyografi; aort; elastik modülü.

Kaynakça

• Arnett FC. Ankylosing spondylitis. In: Koopman WJ (ed). Arthritis and Allied Condition. Lippincott Williams and Wilkins, 2001: 1317.
• van der Linden S, van der Heijde D. Ankylosing spondylitis. Clini- cal features. Rheum Dis Clin North Am 1998;24:663-76.
• 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.
• Gould BA, Turner J, Keeling DH, Hickling P, Marshall AJ. Myo- cardial dysfunction in ankylosing spondylitis. Ann Rheum Dis 1992;51:227-32.
• Peters MJ, van der Horst-Bruinsma IE, Dijkmans BA, Nurmoha- med MT. Cardiovascular risk profi le of patients with spondylarthro- pathies, particularly ankylosing spondylitis and psoriatic arthritis. Semin Arthritis Rheum 2004;34:585-92.
• Moyssakis I, Gialafos E, Vassiliou VA, Boki K, Votteas V, Sfi kakis PP, et al. Myocardial performance and aortic elasticity are impa- ired in patients with ankylosing spondylitis. Scand J Rheumatol 2009;38:216-21.
• Cavalcante JL, Lima JA, Redheuil A, Al-Mallah MH. Aortic stiff- ness: current understanding and future directions. J Am Coll Car- diol 2011;57:1511-22.
• Laurent S, Boutouyrie P, Asmar R, Gautier I, Benetos A, Lacolley P, et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertensi- on 2001;37:1236-41.
• Ahmadi N, Nabavi V, Hajsadeghi F, Flores F, Azmoon S, Ismaeel H, et al. Impaired aortic distensibility measured by computed to- mography is associated with the severity of coronary artery disea- se. Int J Cardiovasc Imaging 2011;27:459-69.
• Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG. Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation 2002;106:2085-90.
• Safar ME, London GM, Plante GE. Arterial stiffness and kidney function. Hypertension 2004;43:163-8.
• Tok D, Özcan F, Kadife İ, Turak O, Başar N, Çağlı K, et al. Elastic properties of the aorta and factors affecting aortic stiffness in pati- ents with metabolic syndrome. Dicle Tıp Dergisi 2012;39:365-70.
• Böger RH. Asymmetric dimethylarginine (ADMA): a novel risk marker in cardiovascular medicine and beyond. Ann Med 2006;38:126-36.
• Demiralp E, Kardesoglu E, Kiralp MZ, Cebeci BS, Keskin I, Oz- men N, et al. Aortic elasticity in patients with ankylosing spondyli- tis. Acta Cardiol 2004;59:630-4.
• Sari I, Kebapcilar L, Alacacioglu A, Bilgir O, Yildiz Y, Taylan A, et al. Increased levels of asymmetric dimethylarginine (ADMA) in pa- tients with ankylosing spondylitis. Intern Med 2009;48:1363-8.
• van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modifi cation of the New York criteria. Arthritis Rheum 1984;27:361-8.
• Erol MK, Yilmaz M, Oztasyonar Y, Sevimli S, Senocak H. Aor- tic distensibility is increasing in elite athletes. Am J Cardiol 2002;89:1002-4.
• Stefanadis C, Stratos C, Boudoulas H, Kourouklis C, Toutouzas P. Distensibility of the ascending aorta: comparison of invasive and non-invasive techniques in healthy men and in men with coronary artery disease. Eur Heart J 1990;11:990-6.
• Ercan S, Goktepe F, Kisacik B, Pehlivan Y, Onat AM, Yavuz F, et al. Subclinical cardiovascular target organ damage manifestations of ankylosing spondylitis in young adult patients. Mod Rheumatol 2012.
• Sakuragi S, Iwasaki J, Tokunaga N, Hiramatsu S, Ohe T. Aortic stiffness is an independent predictor of left ventricular function in patients with coronary heart disease. Cardiology 2005;103:107- 12.
• Gratacós J, Collado A, Filella X, Sanmartí R, Cañete J, Llena J, et al. Serum cytokines (IL-6, TNF-alpha, IL-1 beta and IFN-gamma) in ankylosing spondylitis: a close correlation between serum IL-6 and disease activity and severity. Br J Rheumatol 1994;33:927-31.
• Bal A, Unlu E, Bahar G, Aydog E, Eksioglu E, Yorgancioglu R. Comparison of serum IL-1beta, sIL-2R, IL-6, and TNF-alpha le- vels with disease activity parameters in ankylosing spondylitis. Clin Rheumatol 2007;26:211-5.
• Roldan CA, Chavez J, Wiest PW, Qualls CR, Crawford MH. Aortic root disease and valve disease associated with ankylosing spond- ylitis. J Am Coll Cardiol 1998;32:1397-404.
• Capkin E, Karkucak M, Kiris A, Durmus I, Karaman K, Karaca A, et al. Anti-TNF-α therapy may not improve arterial stiffness in patients with AS: a 24-week follow-up. Rheumatology (Oxford) 2012;51:910-4.
• Boger RH, Maas R, Schulze F, Schwedhelm E. Elevated levels of asymmetric dimethylarginine (ADMA) as a marker of cardiovascu- lar disease and mortality. Clin Chem Lab Med 2005;43:1124-9.
• Erre GL, Sanna P, Zinellu A, Ponchietti A, Fenu P, Sotgia S, et al. Plasma asymmetric dimethylarginine (ADMA) levels and at- herosclerotic disease in ankylosing spondylitis: a cross-sectional study. Clin Rheumatol 2011;30:21-7.