Is left ventricular diastolic function impaired in patients with ankylosing spondylitis?

Abstract

Dear Editor, We read with great interest the article ‘Assessment of serum asymmetric dimethylarginine levels and left ventricular diastolic function in patients with ankylosing spondylitis’ written by Inci et al.1 They aimed to investigate left ventricular diastolic functions and serum dimethylarginine concentrations in patients with ankylosing spondylitis (AS). They detected higher frequency of left ventricular (LV) diastolic dysfunction, even though not statistically significant, in the relatively younger AS patients using standard methods and tissue Doppler imaging. We believe that this findings will act as a guide for further studies regarding echocardiographic evaluation of LV diastolic functions in patients with AS. Some AS patients have cardiac involvement which includes aortitis, aortic insufficiency, myocardial involvement and conduction disturbance.2 A current study showed that diastolic dysfunction was infrequent and mild in patients with AS.3 Many studies have showed that LV diastolic dysfunction usually occurs before apparent LV systolic dysfunction. Therefore, it serves as an early and more easily quantifiable marker of subclinical LV dysfunction. Elevated filling pressures are the main physiologic consequence of diastolic dysfunction. When grading diastolic dysfunction, the E/lateral e’ ratio and septal e’ should be calculated. The E/e’ ratio has been demonstrated to be useful in estimating LV filling pressures in sinus tachycardia and atrial fibrillation.4, 5 An average ratio ≤ 8 identifies patients with normal LV filling pressures, whereas a ratio ≥ 13 indicates an increase in LV filling pressures. When the ratio is between 9 and 13, other measurements are essential. We think that it might be helpful if the exact magnitude of diastolic LV dysfunction were assessed by using these quantitative parameters in patients with AS in further larger studies. There is no conflict of interest.