Insights into cardiac involvement in ankylosing spondylitis from cardiovascular magnetic resonance

P. Stefan Biesbroek; Sjoerd C. Heslinga; Thelma C. Konings; Irene E. van der Horst-Bruinsma; Mark B. M. Hofman; Peter M. van de Ven; Otto Kamp; Vokko P. van Halm; Mike J. L. Peters; Yvo M. Smulders; Albert C. van Rossum; Mike T. Nurmohamed; Robin Nijveldt

doi:https://doi.org/10.1136/heartjnl-2016-310667

Insights into cardiac involvement in ankylosing spondylitis from cardiovascular magnetic resonance

P. Stefan Biesbroek, Sjoerd C. Heslinga, Thelma C. Konings, Irene E. van der Horst-Bruinsma, Mark B. M. Hofman, Peter M. van de Ven, Otto Kamp, Vokko P. van Halm, Mike J. L. Peters, Yvo M. Smulders, Albert C. van Rossum, Mike T. Nurmohamed, Robin Nijveldt

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

OBJECTIVE: To evaluate cardiac involvement in patients with ankylosing spondylitis using cardiac magnetic resonance (CMR).

METHODS: Patients with ankylosing spondylitis without cardiovascular symptoms or known cardiovascular disease were screened by transthoracic echocardiography (TTE) for participation in this exploratory CMR study. We prospectively enrolled 15 ankylosing spondylitis patients with an abnormal TTE for further tissue characterisation using late gadolinium enhancement (LGE) and T1 mapping. T1 mapping was used to calculate myocardial extracellular volume (ECV). Disease activity was assessed by C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) measurements.

RESULTS: In the total of 15 included patients, 14 had a complete CMR exam (mean age 62 years, 93% male and mean disease duration 21 years). Left ventricular (LV) diastolic dysfunction was the most common finding on TTE (79%), followed by aortic root dilatation (14%), right ventricular (RV) dilatation (7%) and RV dysfunction (7%). CMR revealed focal hyperenhancement in three patients (21%), all with a particular pattern of enhancement. LV dysfunction, as defined by a LV ejection fraction below 55%, was observed in five patients (36%). Myocardial ECV was correlated with the CRP concentration (R=0.78, p<0.01) and ESR level (RS=0.73, p<0.01).

CONCLUSIONS: In patients with ankylosing spondylitis, CMR with cine imaging and LGE identified global LV dysfunction and focal areas of hyperenhancement. Myocardial ECV, quantified by CMR T1 mapping, was associated with the degree of disease activity. These results may suggest the presence of cardiac involvement in ankylosing spondylitis and may show the potential of ECV as a marker for disease monitoring.

Original language	English
Article number	310667
Pages (from-to)	745-752
Journal	Heart
Volume	103
Issue number	10
Early online date	16 Nov 2016
DOIs	https://doi.org/10.1136/heartjnl-2016-310667
Publication status	Published - May 2017

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https://doi.org/10.1136/heartjnl-2016-310667

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Biesbroek, P. S., Heslinga, S. C., Konings, T. C., van der Horst-Bruinsma, I. E., Hofman, M. B. M., van de Ven, P. M., Kamp, O., van Halm, V. P., Peters, M. J. L., Smulders, Y. M., van Rossum, A. C., Nurmohamed, M. T., & Nijveldt, R. (2017). Insights into cardiac involvement in ankylosing spondylitis from cardiovascular magnetic resonance. Heart, 103(10), 745-752. Article 310667. https://doi.org/10.1136/heartjnl-2016-310667

@article{e95792d4fb4f44e6939e9213312d4a02,

title = "Insights into cardiac involvement in ankylosing spondylitis from cardiovascular magnetic resonance",

abstract = "OBJECTIVE: To evaluate cardiac involvement in patients with ankylosing spondylitis using cardiac magnetic resonance (CMR).METHODS: Patients with ankylosing spondylitis without cardiovascular symptoms or known cardiovascular disease were screened by transthoracic echocardiography (TTE) for participation in this exploratory CMR study. We prospectively enrolled 15 ankylosing spondylitis patients with an abnormal TTE for further tissue characterisation using late gadolinium enhancement (LGE) and T1 mapping. T1 mapping was used to calculate myocardial extracellular volume (ECV). Disease activity was assessed by C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) measurements.RESULTS: In the total of 15 included patients, 14 had a complete CMR exam (mean age 62 years, 93% male and mean disease duration 21 years). Left ventricular (LV) diastolic dysfunction was the most common finding on TTE (79%), followed by aortic root dilatation (14%), right ventricular (RV) dilatation (7%) and RV dysfunction (7%). CMR revealed focal hyperenhancement in three patients (21%), all with a particular pattern of enhancement. LV dysfunction, as defined by a LV ejection fraction below 55%, was observed in five patients (36%). Myocardial ECV was correlated with the CRP concentration (R=0.78, p<0.01) and ESR level (RS=0.73, p<0.01).CONCLUSIONS: In patients with ankylosing spondylitis, CMR with cine imaging and LGE identified global LV dysfunction and focal areas of hyperenhancement. Myocardial ECV, quantified by CMR T1 mapping, was associated with the degree of disease activity. These results may suggest the presence of cardiac involvement in ankylosing spondylitis and may show the potential of ECV as a marker for disease monitoring.",

author = "Biesbroek, {P. Stefan} and Heslinga, {Sjoerd C.} and Konings, {Thelma C.} and {van der Horst-Bruinsma}, {Irene E.} and Hofman, {Mark B. M.} and {van de Ven}, {Peter M.} and Otto Kamp and {van Halm}, {Vokko P.} and Peters, {Mike J. L.} and Smulders, {Yvo M.} and {van Rossum}, {Albert C.} and Nurmohamed, {Mike T.} and Robin Nijveldt",

year = "2017",

month = may,

doi = "https://doi.org/10.1136/heartjnl-2016-310667",

language = "English",

volume = "103",

pages = "745--752",

journal = "Heart",

issn = "1355-6037",

publisher = "BMJ Publishing Group",

number = "10",

}

Biesbroek, PS, Heslinga, SC, Konings, TC , van der Horst-Bruinsma, IE , Hofman, MBM, van de Ven, PM, Kamp, O , van Halm, VP , Peters, MJL , Smulders, YM , van Rossum, AC , Nurmohamed, MT & Nijveldt, R 2017, 'Insights into cardiac involvement in ankylosing spondylitis from cardiovascular magnetic resonance', Heart, vol. 103, no. 10, 310667, pp. 745-752. https://doi.org/10.1136/heartjnl-2016-310667

TY - JOUR

T1 - Insights into cardiac involvement in ankylosing spondylitis from cardiovascular magnetic resonance

AU - Biesbroek, P. Stefan

AU - Heslinga, Sjoerd C.

AU - Konings, Thelma C.

AU - van der Horst-Bruinsma, Irene E.

AU - Hofman, Mark B. M.

AU - van de Ven, Peter M.

AU - Kamp, Otto

AU - van Halm, Vokko P.

AU - Peters, Mike J. L.

AU - Smulders, Yvo M.

AU - van Rossum, Albert C.

AU - Nurmohamed, Mike T.

AU - Nijveldt, Robin

PY - 2017/5

Y1 - 2017/5

N2 - OBJECTIVE: To evaluate cardiac involvement in patients with ankylosing spondylitis using cardiac magnetic resonance (CMR).METHODS: Patients with ankylosing spondylitis without cardiovascular symptoms or known cardiovascular disease were screened by transthoracic echocardiography (TTE) for participation in this exploratory CMR study. We prospectively enrolled 15 ankylosing spondylitis patients with an abnormal TTE for further tissue characterisation using late gadolinium enhancement (LGE) and T1 mapping. T1 mapping was used to calculate myocardial extracellular volume (ECV). Disease activity was assessed by C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) measurements.RESULTS: In the total of 15 included patients, 14 had a complete CMR exam (mean age 62 years, 93% male and mean disease duration 21 years). Left ventricular (LV) diastolic dysfunction was the most common finding on TTE (79%), followed by aortic root dilatation (14%), right ventricular (RV) dilatation (7%) and RV dysfunction (7%). CMR revealed focal hyperenhancement in three patients (21%), all with a particular pattern of enhancement. LV dysfunction, as defined by a LV ejection fraction below 55%, was observed in five patients (36%). Myocardial ECV was correlated with the CRP concentration (R=0.78, p<0.01) and ESR level (RS=0.73, p<0.01).CONCLUSIONS: In patients with ankylosing spondylitis, CMR with cine imaging and LGE identified global LV dysfunction and focal areas of hyperenhancement. Myocardial ECV, quantified by CMR T1 mapping, was associated with the degree of disease activity. These results may suggest the presence of cardiac involvement in ankylosing spondylitis and may show the potential of ECV as a marker for disease monitoring.

AB - OBJECTIVE: To evaluate cardiac involvement in patients with ankylosing spondylitis using cardiac magnetic resonance (CMR).METHODS: Patients with ankylosing spondylitis without cardiovascular symptoms or known cardiovascular disease were screened by transthoracic echocardiography (TTE) for participation in this exploratory CMR study. We prospectively enrolled 15 ankylosing spondylitis patients with an abnormal TTE for further tissue characterisation using late gadolinium enhancement (LGE) and T1 mapping. T1 mapping was used to calculate myocardial extracellular volume (ECV). Disease activity was assessed by C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) measurements.RESULTS: In the total of 15 included patients, 14 had a complete CMR exam (mean age 62 years, 93% male and mean disease duration 21 years). Left ventricular (LV) diastolic dysfunction was the most common finding on TTE (79%), followed by aortic root dilatation (14%), right ventricular (RV) dilatation (7%) and RV dysfunction (7%). CMR revealed focal hyperenhancement in three patients (21%), all with a particular pattern of enhancement. LV dysfunction, as defined by a LV ejection fraction below 55%, was observed in five patients (36%). Myocardial ECV was correlated with the CRP concentration (R=0.78, p<0.01) and ESR level (RS=0.73, p<0.01).CONCLUSIONS: In patients with ankylosing spondylitis, CMR with cine imaging and LGE identified global LV dysfunction and focal areas of hyperenhancement. Myocardial ECV, quantified by CMR T1 mapping, was associated with the degree of disease activity. These results may suggest the presence of cardiac involvement in ankylosing spondylitis and may show the potential of ECV as a marker for disease monitoring.

U2 - https://doi.org/10.1136/heartjnl-2016-310667

DO - https://doi.org/10.1136/heartjnl-2016-310667

M3 - Article

C2 - 27852696

SN - 1355-6037

VL - 103

SP - 745

EP - 752

JO - Heart

JF - Heart

IS - 10

M1 - 310667

ER -