University Grenoble Alpes, T-RAIG, TIMC-IMAG, CNRS UMR 5525, Grenoble, France; Department of Rheumatology, Grenoble Alpes University Hospital, 38130 Échirolles, Grenoble, France.
Department of Rheumatology, Grenoble Alpes University Hospital, 38130 Échirolles, Grenoble, France.
Joint Bone Spine. 2022 Jul;89(4):105375. doi: 10.1016/j.jbspin.2022.105375. Epub 2022 Mar 5.
Axial Spondyloarthritis (ax-SpA) is associated with increased risk of cardiovascular disease (CVD)-specific deaths. We aimed to assess the prevalence of left ventricular (LV) systolic and diastolic dysfunction and valvular heart disease (VHD) by transthoracic echocardiography (TTE) in ax-SpA patients without history of CVD.
A systematic literature review was performed in PUBMED, Embase, Cochrane Library databases published before April 2020. We included all controlled studies assessing myocardial function and heart valve by TTE in ax-SpA without history of CVD. A meta-analysis was performed with random or fixed effects model estimating mean differences (MD) and odds ratio (OR).
Literature search selected 189 abstracts and 28 articles were included (1471 ax-SpA and 1115 controls). ax-SpA had a statistically slight alteration of LV ejection fraction (MD=0.64%, 95%CI: 0.14-1.14). ax-SpA had more frequently LV diastolic dysfunction (OR=3.43, 95%CI: 1.78-6.59) and an alteration of E/A ratio (MD=0.15, 95%CI: 0.08-0.21), deceleration time (MD=13.07ms, 95%CI: 7.75-18.40), isovolumetric relaxation time (MD=7.90ms, 95%CI: 4.50-11.30), left-ventricular end diastolic (MD=0.57mm, 95%CI: 0.19-0.95) and systolic (MD=0.77mm, 95%CI: 0.36-1.17) diameters. Three studies (15%) used a combination of TTE parameters to diagnose LV diastolic dysfunction. Prevalence of mitral regurgitation and aortic regurgitation were similar in ax-SpA patients and healthy individuals.
ax-SpA have a non-clinically relevant alteration of LV ejection fraction and similar prevalence of VHD compared to healthy individuals. LV diastolic TTE parameters are altered in ax-SpA. However, most studies do not combine set of parameters to recognize diastolic dysfunction. The clinical relevance of diastolic dysfunction observed by TTE remains to be determined in future longitudinal studies.
强直性脊柱炎（ax-SpA）与心血管疾病（CVD）特异性死亡风险增加相关。我们旨在评估无 CVD 病史的 ax-SpA 患者经胸超声心动图（TTE）检查左心室（LV）收缩和舒张功能障碍及瓣膜性心脏病（VHD）的患病率。
我们在 PUBMED、Embase 和 Cochrane 图书馆数据库中进行了系统的文献检索，检索时间截至 2020 年 4 月前发表的文献。我们纳入了所有经 TTE 评估无 CVD 病史的 ax-SpA 患者心肌功能和心脏瓣膜的对照研究。采用随机或固定效应模型进行荟萃分析，以评估均数差值（MD）和比值比（OR）。
文献检索筛选出 189 篇摘要，28 篇文章被纳入（1471 例 ax-SpA 和 1115 例对照）。ax-SpA 的左心室射血分数（MD=0.64%，95%CI：0.14-1.14）有统计学上的轻微改变。ax-SpA 更常发生 LV 舒张功能障碍（OR=3.43，95%CI：1.78-6.59）和 E/A 比值改变（MD=0.15，95%CI：0.08-0.21）、减速时间（MD=13.07ms，95%CI：7.75-18.40）、等容舒张时间（MD=7.90ms，95%CI：4.50-11.30）、左心室舒张末期（MD=0.57mm，95%CI：0.19-0.95）和收缩末期（MD=0.77mm，95%CI：0.36-1.17）直径。三项研究（15%）使用 TTE 参数组合来诊断 LV 舒张功能障碍。ax-SpA 患者与健康个体的二尖瓣反流和主动脉瓣反流患病率相似。
与健康个体相比，ax-SpA 的左心室射血分数仅有非临床相关的改变，且 VHD 的患病率相似。ax-SpA 的 LV 舒张 TTE 参数发生改变。然而，大多数研究并未将一组参数相结合来识别舒张功能障碍。TTE 观察到的舒张功能障碍的临床意义尚需在未来的纵向研究中确定。
