Yildiz Mehmet, Dedeoglu Reyhan, Akdeniz Beste, Adrovic Amra, Haslak Fatih, Karagozlu Fatih, Koker Oya, Ulug Nujin, Sahin Sezgin, Barut Kenan, Oztunc Funda, Kasapcopur Ozgur
From the Departments of Pediatric Rheumatology.
Pediatric Cardiology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.
J Clin Rheumatol. 2022 Jan 1;28(1):e175-e179. doi: 10.1097/RHU.0000000000001674.
BACKGROUND/OBJECTIVE: Juvenile spondyloarthropathies (JSpAs) are a group of inflammatory diseases characterized by asymmetric peripheral arthritis (especially in lower extremities), axial skeleton involvement, and enthesitis. Although cardiovascular findings of inflammatory diseases such as juvenile systemic lupus erythematosus (SLE) and juvenile scleroderma (SD) are well documented, there are only a few studies assessing the cardiovascular consequences of JSpA in the literature.
Forty patients with JSpA and 20 healthy controls were included into this cross-sectional study. Cardiac functions of the participants were evaluated by conventional echocardiography and pulse-wave (PW) tissue Doppler.
The patients with JSpA had higher mitral lateral S (p = 0.005) and E' wave (p < 0.001), tricuspid A' wave (p = 0.03), ejection fraction (p = 0.03) and shortening fraction (p = 0.01) than the control patients. In contrast, the patients with JSpA had lower left ventricle MPI (p = 0.01) and the ratio of tricuspid E'/A' waves (p = 0.05). Patients with enthesitis detected on magnetic resonance imaging had lower ejection fraction (p = 0.05), the ratio of E/A waves (p = 0.03) and had higher Mitral lateral A' wave (p = 0.01) than those without. There was a significant inverse correlation between the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and PW transmitral A velocity (r = -0.256, p = 0.03), the BASDAI score and tricuspid annular plane systolic excursion (r = -0.301, p = 0.04), the BASDAI score and the ratio of E/E' waves (r = -0.276, p = 0.02), and the Juvenile Spondyloarthritis Disease Activity Index and PW transmitral A velocity (r = -0.246, p = 0.04).
In this study, we report the possible early signs of RV diastolic dysfunction and possible association between magnetic resonance imaging-confirmed enthesitis and lower LV systolic functions. Early identification of cardiac dysfunctions can help with prevention of long-term cardiovascular complications.
背景/目的：青少年脊柱关节炎（JSpA）是一组炎症性疾病，其特征为不对称性外周关节炎（尤其是下肢）、中轴骨骼受累和附着点炎。虽然青少年系统性红斑狼疮（SLE）和青少年硬皮病（SD）等炎症性疾病的心血管表现已有充分记录，但文献中评估JSpA心血管后果的研究较少。
本横断面研究纳入了40例JSpA患者和20名健康对照者。通过传统超声心动图和脉冲波（PW）组织多普勒评估参与者的心脏功能。
与对照患者相比，JSpA患者的二尖瓣外侧S波（p = 0.005）和E'波（p < 0.001）、三尖瓣A'波（p = 0.03）、射血分数（p = 0.03）和缩短分数（p = 0.01）更高。相反，JSpA患者的左心室心肌做功指数（p = 0.01）和三尖瓣E'/A'波比值（p = 0.05）更低。磁共振成像检测到附着点炎的患者比未检测到的患者射血分数更低（p = 0.05）、E/A波比值更低（p = 0.03），二尖瓣外侧A'波更高（p = 0.01）。巴斯强直性脊柱炎疾病活动指数（BASDAI）与PW二尖瓣A峰流速之间存在显著负相关（r = -0.256，p = 0.03），BASDAI评分与三尖瓣环平面收缩期位移之间存在显著负相关（r = -0.301，p = 0.04），BASDAI评分与E/E'波比值之间存在显著负相关（r = -0.276，p = 0.02），青少年脊柱关节炎疾病活动指数与PW二尖瓣A峰流速之间存在显著负相关（r = -0.246，p = 0.04）。
在本研究中，我们报告了右心室舒张功能障碍的可能早期迹象，以及磁共振成像证实的附着点炎与左心室收缩功能降低之间的可能关联。早期识别心脏功能障碍有助于预防长期心血管并发症。
