Diastolic left ventricular dysfunction in ankylosing spondylitis--a systematic review and meta-analysis.

OBJECTIVES:Ankylosing spondylitis (AS) is associated with increased mortality largely due to cardiovascular disease. Diastolic left ventricular (LV) dysfunction serves as a precursor to chronic heart failure and may cause morbidity and mortality. A systematic literature search was conducted to determine the prevalence of diastolic LV dysfunction in patients with AS. METHODS:We identified all echocardiographic studies investigating diastolic LV function in patients with AS. The initial search yielded 166 studies of which 11 met the inclusion criteria. RESULTS:Compared to control subjects, AS patients had a worse E/A ratio [mean difference -0.13 m/s (95% CI: -0.19 to -0.07)], a prolonged deceleration time [mean difference 13.90 ms (95% CI: 6.03-21.78)], and a prolonged mean isovolumetric relaxation time [mean difference 8.06 ms (95% CI: 3.23-12.89)], all suggestive of diastolic LV dysfunction. The best way to establish diastolic LV dysfunction, however, is to combine E/A ratio, deceleration time, and isovolumetric relaxation time. The latter has been done in 3 studies, all reaffirming an increased prevalence rate of diastolic LV dysfunction in AS patients as compared with control subjects, i.e., 9% versus 0%, 30% versus 12%, and 45% versus 18%, respectively. CONCLUSIONS:Our observations support the current evidence base for an increased risk of diastolic LV dysfunction in AS. However, larger studies are needed to investigate the exact magnitude of diastolic LV dysfunction and its clinical relevance in patients with AS.