Roldan C A, Chavez J, Wiest P W, Qualls C R, Crawford M H
Division of Cardiology, Veterans Affairs Medical Center, Albuquerque, New Mexico 87108, USA.
J Am Coll Cardiol. 1998 Nov;32(5):1397-404. doi: 10.1016/s0735-1097(98)00393-3.
This study sought to determine the prevalence, characteristics, relation to clinical features and evolution of aortic root disease and valve disease associated with ankylosing spondylitis (AKS).
Aortic root disease and valve disease are common in patients with AKS, but their clinical and prognostic implications have not been well defined.
Forty-four outpatients with AKS and 30 age- and gender-matched healthy volunteers underwent initial transesophageal echocardiography and rheumatologic evaluations. Twenty-five patients underwent clinical and echocardiographic follow-up 39+/-10 months later.
Aortic root disease and valve disease were common in patients (82%) as compared with controls (27%; p < 0.001). Aortic root thickening, increased stiffness and dilatation were seen in 61%, 61% and 25% of patients, respectively. Valve thickening (41% for the aortic and 34% for the mitral valve) manifested predominantly (74%) as nodularities of the aortic cusps and basal thickening of the anterior mitral leaflet, forming the characteristic subaortic bump. Valve regurgitation was seen in almost half of patients, and 40% had moderate lesions. Except for the duration of AKS, aortic root disease and valve disease were unrelated to the activity, severity or therapy of AKS. During follow-up of 25 patients, in up to 24% new aortic root or valve abnormalities developed, in 12% existing valve regurgitation worsened significantly and in 20% abnormalities resolved. Twenty percent of patients developed heart failure, underwent valve replacement, had a stroke or died, as compared with 3% of control subjects.
Aortic root disease and valve disease are common in patients with AKS, are unrelated to clinical features of AKS, can resolve or progress over time and are associated with clinically important cardiovascular morbidity.
本研究旨在确定与强直性脊柱炎（AKS）相关的主动脉根部疾病和瓣膜疾病的患病率、特征、与临床特征的关系以及病情演变。
主动脉根部疾病和瓣膜疾病在AKS患者中很常见，但其临床和预后意义尚未明确界定。
44例AKS门诊患者和30例年龄及性别匹配的健康志愿者接受了初次经食管超声心动图检查和风湿病评估。25例患者在39±10个月后接受了临床和超声心动图随访。
与对照组（27%；p<0.001）相比，患者中主动脉根部疾病和瓣膜疾病很常见（82%）。分别有61%、61%和25%的患者出现主动脉根部增厚、僵硬度增加和扩张。瓣膜增厚（主动脉瓣为41%，二尖瓣为34%）主要表现为主动脉瓣叶结节（74%）和二尖瓣前叶基部增厚，形成特征性的主动脉下隆起。近一半患者出现瓣膜反流，40%有中度病变。除了AKS的病程外，主动脉根部疾病和瓣膜疾病与AKS的活动度、严重程度或治疗无关。在25例患者的随访中，高达24%出现了新的主动脉根部或瓣膜异常，12%现有的瓣膜反流显著加重，20%的异常消失。20%的患者发生心力衰竭、接受瓣膜置换、中风或死亡，而对照组为3%。
主动脉根部疾病和瓣膜疾病在AKS患者中很常见，与AKS的临床特征无关，可随时间缓解或进展，并与具有临床重要意义的心血管疾病相关。
