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Assessment of aortic stiffness in patients with ankylosing spondylitis using cardiovascular magnetic resonance

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Abstract

To evaluate aortic stiffness in patients with ankylosing spondylitis (AS) using cardiovascular magnetic resonance (CMR) and to assess its association with AS characteristics and left ventricular (LV) remodeling. In this prospective study, 14 consecutive AS patients were each matched to two controls without cardiovascular symptoms or known cardiovascular disease who underwent CMR imaging for the assessment of aortic arch pulse wave velocity (PWV) at 1.5 Tesla. To enhance comparability of the samples, matching was done with replacement resulting in 20 unique controls. Only AS patients with abnormal findings on screening echocardiography were included in this exploratory study. Cine CMR was used to assess LV geometry and systolic function, and late gadolinium enhancement was performed to determine the presence of myocardial hyperenhancement (i.e., fibrosis). Aortic arch PWV was significantly higher in the AS group compared with the control group (median 9.7 m/s, interquartile range [IQR] 7.1 to 11.8 vs. 6.1 m/s, IQR 4.6 to 7.6 m/s; p < 0.001). PWV was positively associated with functional disability as measured by BASFI (R: 0.62; p = 0.018). Three patients (21%) with a non-ischemic pattern of hyperenhancement showed increased PWV (11.7, 12.3, and 16.5 m/s) as compared to the 11 patients without hyperenhancement (9.0 m/s, IQR 6.6 to 10.5 m/s; p = 0.022). PWV was inversely associated with LV ejection fraction (R: − 0.63; p = 0.015), but was not found to be statistically correlated to LV volumes or mass. Aortic arch PWV was increased in our cohort of patients with AS. Higher PWV in the aortic arch was associated with functional disability, the presence of non-ischemic hyperenhancement, and reduced LV systolic function.

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Acknowledgements

We acknowledge financial support by the Dutch Arthritis Foundation (Reumafonds), the Netherlands, and in part by grant UL1TR001105 from the National Center for Advancing Translational Science, National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Center for Translational Medicine, The University of Texas Southwestern Medical Center and its affiliated academic and health care centers, the National Center for Advancing Translational Sciences, or the National Institutes of Health.

Funding

This work was supported by the Dutch Arthritis Foundation (Reumafonds), the Netherlands, and in part by grant UL1TR001105 from the National Center for Advancing Translational Science, National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Center for Translational Medicine, The University of Texas Southwestern Medical Center and its affiliated academic and health care centers, the National Center for Advancing Translational Sciences, or the National Institutes of Health. The funding source had no role in the collection, analysis, and interpretation of data; in writing the report; and in the decision to submit the article for publication.

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Author notes

  1. P. Stefan Biesbroek and Sjoerd C. Heslinga contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, 5F, VU University Medical Center, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands

    P. Stefan Biesbroek, Raquel P. Amier, Thelma C. Konings, Vokko P. van Halm, Albert C. van Rossum & Robin Nijveldt

  2. Netherlands Heart Institute, Utrecht, The Netherlands

    P. Stefan Biesbroek

  3. Amsterdam Rheumatology and immunology Center, Rheumatology, Reade, Amsterdam, The Netherlands

    Sjoerd C. Heslinga & Michael T. Nurmohamed

  4. Amsterdam Rheumatology and immunology Center, Rheumatology, VU University Medical Center, Amsterdam, The Netherlands

    Sjoerd C. Heslinga, Irene E. van der Horst-Bruinsma & Michael T. Nurmohamed

  5. Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands

    Peter M. van de Ven

  6. Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands

    Mike J. L. Peters

  7. Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Christopher D. Maroules

  8. Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Colby Ayers

  9. Department of Medicine (Cardiology), University of Texas Southwestern Medical Center, Dallas, TX, USA

    Parag H. Joshi

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  1. P. Stefan Biesbroek
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Correspondence to Robin Nijveldt.

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The present study was conducted in accordance with the Declaration of Helsinki, was approved by the institutional review board (Ethics Committee of the Slotervaart Hospital and Reade, Amsterdam, The Netherlands, NL44202.048.13), and all patients gave written informed consent.

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Biesbroek, P.S., Heslinga, S.C., van de Ven, P.M. et al. Assessment of aortic stiffness in patients with ankylosing spondylitis using cardiovascular magnetic resonance. Clin Rheumatol 37, 2151–2159 (2018). https://doi.org/10.1007/s10067-018-4135-x

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