Eddarami Jalila, Azzouzi Hamida, Ichchou Linda
Department of Rheumatology, Mohamed VI University Hospital, Oujda, Morocco.
Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco.
J Saudi Heart Assoc. 2021 Jul 8;33(2):191-197. doi: 10.37616/2212-5043.1258. eCollection 2021.
The aim of this study was to investigate the prevalence of cardiac manifestations and their predictive factors in Moroccan patients with spondyloarthritis (SpA).
We have conducted a cross-sectional study over four months at the Department of Rheumatology in Mohammed VI University Hospital of Oujda, Morocco. All SpA patients fulfilled the 2009 Assessment SpondyloArthritis international Society (ASAS) criteria. Every patient had a cardiac check up including clinical examination, 12-lead electrocardiogram (ECG) and transthoracic echocardiography (TTE). Multiple logistic regression was used to analyze the associated factors with cardiac manifestations.
We included 64 men and 30 women with a mean age of 37.32 ± 12.65 years old. The mean disease duration was 10.60 ± 7.61 years. Patients had a mean Ankylosing Spondylitis Disease Activity Score (ASDAS) CRP of 2.25 ± 1.38, a mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of 2.88 ± 2.26 and a mean Bath Ankylosing Spondylitis Functional Index (BASFI) of 33.52 ± 30.49. Traditional cardiovascular risk factors (CVRF) included dyslipidemia in 14.9%, hypertension in 9.6% and type 2 diabetes in 7.4% of the cases. Eight patients (8.5%) smoked and 3 patients (3.2%) used alcohol whereas 20 patients (21.3%) had a history of smoking and 5 patients (6.3%) a history of alcohol. Cardiac manifestations were found in 12 patients (13.3%): 3.3% had aortic regurgitation (AR), 1.1% had aortic dilatation, 1.1% had aortic valve thickening (AVT), 2.2% had mitral thickening, 1.1% had mitral regurgitation (MR), 1.1% had mitral stenosis (MS), 3.3 had pericarditis and 2.2% had complete right bundle branch block (RBBB). In multivariate analysis, cardiac involvement was significantly associated with extra-articular manifestations (OR = 6.05; 95% CI: 1.197-30.607, p = 0.029).
Based on these results, cardiac involvement was common and associated with the severity of the disease; hence, early detection of cardiac abnormalities and targeted treatment strategies of SpA and comorbidities are necessary to control the systemic inflammation and improve the excess of cardiovascular mortality in this group of patients.
本研究旨在调查摩洛哥脊柱关节炎（SpA）患者心脏表现的患病率及其预测因素。
我们在摩洛哥乌季达穆罕默德六世大学医院风湿病科进行了为期四个月的横断面研究。所有SpA患者均符合2009年脊柱关节炎国际评估协会（ASAS）标准。每位患者均进行了心脏检查，包括临床检查、12导联心电图（ECG）和经胸超声心动图（TTE）。采用多因素logistic回归分析与心脏表现相关的因素。
我们纳入了64名男性和30名女性，平均年龄为37.32±12.65岁。平均病程为10.60±7.61年。患者的强直性脊柱炎疾病活动评分（ASDAS）CRP平均值为2.25±1.38，巴斯强直性脊柱炎疾病活动指数（BASDAI）平均值为2.88±2.26，巴斯强直性脊柱炎功能指数（BASFI）平均值为33.52±30.49。传统心血管危险因素（CVRF）包括血脂异常（14.9%）、高血压（9.6%）和2型糖尿病（7.4%）。8名患者（8.5%）吸烟，3名患者（3.2%）饮酒，而20名患者（21.3%）有吸烟史，5名患者（6.3%）有饮酒史。12名患者（13.3%）出现心脏表现：3.3%有主动脉反流（AR），1.1%有主动脉扩张，1.1%有主动脉瓣增厚（AVT），2.2%有二尖瓣增厚，1.1%有二尖瓣反流（MR），1.1%有二尖瓣狭窄（MS），3.3%有心肌炎，2.2%有完全性右束支传导阻滞（RBBB）。多因素分析显示，心脏受累与关节外表现显著相关（OR = 6.05；95%CI：1.197 - 30.607，p = 0.029）。
基于这些结果，心脏受累较为常见且与疾病严重程度相关；因此，早期发现心脏异常以及针对SpA和合并症的靶向治疗策略对于控制全身炎症和改善该组患者心血管死亡率过高的情况是必要的。
