Abstract
INTRODUCTION: Cardiopulmonary complications are common in ankylosing spondylitis (AS) and psoriatic arthritis (PsA) and have an adverse impact on the mortality and quality of life of patients. Myocardial involvement can lead to systolic and diastolic dysfunction, which can be asymptomatic for a long time. Chest wall rigidity, a complication of both diseases, can also lead to cardiac dysfunction, especially in the right heart-pulmonary circulation unit. We aimed to assess the response of the pulmonary circulation-right ventricular function unit and left ventricular function during exercise in AS and PsA patients and hypothesized that stress echocardiography may unmask the early non-invasive hemodynamic changes caused by chest wall rigidity and left heart involvement. METHODS: A total of 72 participants were enrolled in the study: 26 had AS, 18 had PsA, and 28 healthy individuals were matched by age and sex. To assess the maximally tolerated workload, all subjects underwent resting and exercise stress echocardiography on a supine bicycle ergometer. Echocardiographic measurements were taken at rest, at 50 watts workload, and at maximal exercise. Detailed clinical characteristics were also assessed, including the advanced ankylotic axial status of both patient groups. RESULTS: At rest, only pulmonary vascular resistance (PVR) values were significantly higher in patients with AS and PsA than in controls. During exercise, the tricuspid regurgitation velocity (TRV) was significantly increased in the AS and PsA groups. PVR stress was significantly higher in patients with AS and PsA than in controls. E/e', which refers to estimation of the left ventricular filling pressure, significantly increases during stress in patients with AS and in the ankylotic group compared to controls at peak stress. In patients with AS and those with PsA, the disease duration was strongly correlated with E/e' mean measured during peak stress but not with TRV or PVR. DISCUSSION: Stress echocardiography is a promising method for assessing subclinical cardiopulmonary changes among AS and PsA patients. Changes in PVR during stress may highlight pulmonary complications related to chest wall restriction and remodeling of the pulmonary vasculature at the subclinical stage.