当代荷兰老年强直性脊柱炎患者大型队列中心脏病的患病率——CARDAS研究
The Prevalence of Cardiac Diseases in a Contemporary Large Cohort of Dutch Elderly Ankylosing Spondylitis Patients-The CARDAS Study.
作者信息
Baniaamam Milad, Heslinga Sjoerd C, Boekel Laura, Konings Thelma C, Handoko M Louis, Kamp Otto, van Halm Vokko P, van der Horst-Bruinsma Irene E, Nurmohamed Mike T
机构信息
Reade Rheumatology, Amsterdam Rheumatology and Immunology Center, 1056 AB Amsterdam, The Netherlands.
Amsterdam Cardiovascular Sciences, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands.
出版信息
J Clin Med. 2021 Oct 29;10(21):5069. doi: 10.3390/jcm10215069.
OBJECTIVES
The aim of the present study was to determine the prevalence of specific cardiac manifestations, i.e., conduction disorders, valvular disease and diastolic left ventricular (LV) dysfunction, in a large cross-sectional controlled cohort of elderly ankylosing spondylitis (AS) patients.
METHODS
This cross-sectional study assessed the prevalence of valvular disease, conduction disorders and LV dysfunction in 193 randomly selected AS patients compared with 74 osteoarthritis (OA) controls aged 50-75 years. Patients underwent conventional and tissue Doppler echocardiography in combination with clinical and laboratory assessments. Multivariate regression analyses were performed to compare the odds of mitral valve regurgitation (MVR) and aortic valve regurgitation (AVR) between AS patients and OA controls.
RESULTS
The prevalence of diastolic dysfunction was trivial and comparable in AS patients compared to controls (respectively, 4% and 3%) and had no further clinical relevance. In addition, the prevalence of conduction disturbances was similar in both groups, with little clinical relevance, respectively 23% vs. 24%. The prevalence of AVR was significantly higher in AS patients compared to the controls, respectively 23% (9% trace, 12% mild, 1% moderate, 1% severe, 1% prosthesis) vs. 11%, = 0.04. After correcting for age, sex and CV risk factors, AS patients had an odds ratio of 4.5 (95% CI 1.1-13.6) for AVR compared to the controls. In contrast, the prevalence values of MVR were similar and mostly not clinically relevant in AS patients and controls, respectively 36% and 32% and = 0.46.
CONCLUSION
The prevalence of diastolic LV dysfunction and conduction disorders was mostly not clinically relevant, and similar in AS patients and controls. However, AS patients had an up to five times increased odds to develop AVR compared to controls. Therefore, echocardiographic screening of elderly (50-75 years) AS patients should be considered.
目的
本研究旨在确定在一个大型横断面对照队列的老年强直性脊柱炎（AS）患者中，特定心脏表现的患病率，即传导障碍、瓣膜疾病和舒张期左心室（LV）功能障碍。
方法
这项横断面研究评估了193例随机选择的AS患者与74例年龄在50 - 75岁的骨关节炎（OA）对照者中瓣膜疾病、传导障碍和LV功能障碍的患病率。患者接受了传统和组织多普勒超声心动图检查，并结合临床和实验室评估。进行多变量回归分析以比较AS患者和OA对照者之间二尖瓣反流（MVR）和主动脉瓣反流（AVR）的几率。
结果
与对照组相比，AS患者舒张功能障碍的患病率微不足道且相当（分别为4%和3%），且无进一步临床意义。此外，两组传导障碍的患病率相似，临床意义不大，分别为23%对24%。与对照组相比，AS患者中AVR的患病率显著更高，分别为23%（微量9%，轻度12%，中度1%，重度1%，人工瓣膜1%）对11%，P = 0.04。在校正年龄、性别和心血管危险因素后，与对照组相比，AS患者发生AVR的几率比为4.5（95%CI 1.1 - 13.6）。相比之下，AS患者和对照组中MVR的患病率相似，且大多无临床意义，分别为36%和32%，P = 0.46。
结论
舒张期LV功能障碍和传导障碍的患病率大多无临床意义，且在AS患者和对照组中相似。然而，与对照组相比，AS患者发生AVR的几率增加了多达五倍。因此，应考虑对老年（50 - 75岁）AS患者进行超声心动图筛查。
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