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SAT0037 Myocardial involvement in patients with ankylosing spondylitis

Background Ankylosing spondylitis (AS) is a chronic systemic disease that may involve aorta and the heart. Aortitis, aortic valve insufficiency, pericarditis, cardiac conduction abnormalities and cardiomegaly have been reported in patients with AS. It is not clear whether cardiac muscle changes are due to primary involvement of the cardiac muscle or secondary to aortic and valvular involvement in this disease. Objectives To evaluate the presence of ongoing myocyte necrosis in patients with active AS. Methods 8 patients with active AS (2 women and 6 men, mean age 36 years) were included in this study. AS was diagnosed according to the New-York criteria. Disease activity was assessed by erythrocyte sedimentation rate (ESR) and serum levels of C-reactive protein (CRP). None of the patients had macrovascular complications such as hypertension or clinical evidence of cardiac valvular insufficiency. Sex- and age-matched 8 healthy adults formed the control group. Myocardial involvement was evaluated by serum levels of cardiac specific troponin-I, an intracellular cardiac protein that is not detected in blood unless myocyte necrosis occurs. Results Mean duration of disease activity was 8 years. Electrocardiograms were normal in all subjects. The ESR and CRP levels were elevated in all patients with AS (mean values were 39 mm/h and 34 mg/l respectively) while they were normal in controls (mean values were 11 mm/h and 2 mg/l respectively). Cardiac specific troponin-I was not detected in the serum of any subject. Conclusion The absence of cardiac specific troponin-I in the serum of patients with active AS suggest that there is no ongoing primary myocyte necrosis in the active stage of this disease. Previously reported cardiac abnormalities in this disease can be the result of aortic involvement including aortic vave insufficiency. References Van Der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New-York criteria. Arthritis Rheum. 1984;27:361–8 Bergfeldt L, Insulander P, Lindblom D, et al. HLA-B27: an important genetic risk factor for lone aortic regurgitation and severe conduction system abnormalities. Am J Med. 1988;85:12–18 Graham DC, Smythe HA. The carditis and aortitis of ankylosing spondylitis. Bull Rheum Dis. 1958;9:171–4