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