Two-dimensional echo Doppler findings in juvenile and adult onset ankylosing spondylitis with long-term disease

The authors' objective was to determine by 2-dimensional echo Doppler (2DEC HO) the cardiac abnormalities in juvenile onset ankylosing spondylitis (JOA S) and adult onset ankylosing spondylitis (AOAS) in male patients with long -term disease. Twenty patients with JOAS, 31 with AOAS, and 20 healthy cont rols of the same age and gender without cardiopulmonary symptoms were studi ed. Using 2DECHO, the heart dimensions were determined according to America n Society of Echocardiography guidelines. The left ventricle ejection fract ion (LVEF) was calculated by Teichholz's formula. Cardiomyopathy was establ ished when 2DECHO had diminished LVEF. Statistics used were the Student t a nd Fisher test, chi (2), and ANOVA. Ninety percent of JOAS and 51% of AOAS patients were B27+ (p = 0.005). The disease duration was 19.3 +/- 8.8 years in JOAS and 14.8 +/- 12.8 years in AOAS (p = NS). Age at the time of the s tudy was 30.7 +/- 9.9 years in JOAS vs 40.3 +/- 12.7 in AOAS (p = 0.003), a nd vs 40.2 +/- 17 years in controls (p = NS), There was a higher frequency of cardiomyopathy in AOAS (32.2%) than in JOAS (25%) and the controls (0%) (p = 0.01). Patients with JOAS had a higher mitral valve gradient (25%) tha n AOAS patients (19%, p = NS) and controls (0%, p = 0.04). Abnormal aortic ring reflectance was shown in 19% of AOAS vs 0% abnormalities in JOAS and c ontrols (p = 0.01). The aortic root diameter was increased in 58% of AOAS, 30% of JOAS, and 0% of controls (p = 0.001). The frequency of 2DECHO abnormalities was increased in cardiopulmonary asym ptomatic spondylitis patients. Despite the high frequency of B27+, JOAS had a lower frequency of aortic abnormalities than AOAS, Mitral valve gradient was found in JOAS and in AOAS that could contribute to a decreased ejectio n fraction and to left ventricular dysfunction.