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Original article
Cardiac conduction disturbances in patients with ankylosing spondylitis: results from a 5-year follow-up cohort study
  1. Karin Bengtsson1,2,
  2. Eva Klingberg1,2,
  3. Anna Deminger1,2,
  4. Hanna Wallberg3,
  5. Lennart T H Jacobsson1,2,
  6. Lennart Bergfeldt4,5 and
  7. Helena Forsblad-d’Elia1,6
  1. 1Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
  2. 2Department of Rheumatology, Sahlgrenska University Hospital, Västra Götalandsregionen, Gothenburg, Sweden
  3. 3Department of Anesthesiology and Intensive Care, NU Hospital Group, Västra Götalandsregionen, Trollhättan, Sweden
  4. 4Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
  5. 5Department of Cardiology, Sahlgrenska University Hospital, Västra Götalandsregionen, Gothenburg, Sweden
  6. 6Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå, Sweden
  1. Correspondence to Dr Karin Bengtsson; karin.si.bengtsson{at}vgregion.se

Abstract

Objectives To describe electrocardiographic (ECG) development in patients with ankylosing spondylitis (AS) and identify associations between baseline characteristics and cardiac conduction disturbances (CCD) at 5-year follow-up.

Methods In a longitudinal cohort study, 172 patients (54% men, mean age (SD) of 50 (13) years at baseline) with AS underwent ECG, physical examination, questionnaires and laboratory testing at baseline and at 5-year follow-up. Descriptive statistics and univariate and age- and sex-adjusted logistic regression analyses were used. CCD included both atrioventricular and intraventricular blocks.

Results Twenty-three of the 172 patients (13.4%) had a CCD at follow-up. Eight patients had developed a new CCD and eight had normalised their ECG. In the age- and sex-adjusted analyses, CCD at baseline (OR 24.8, 95% CI 7.3 to 84.5), male sex (OR 6.4, 95% CI 2.0 to 20.8), history of anterior uveitis (OR 4.4, 95% CI 1.3 to 14.5), higher ASDAS-CRP (OR 2.3, 95% CI 1.3 to 4.0), greater waist circumference (OR 1.3, 95% CI 1.1 to 1.6, per 5 cm), and medication with antiplatelets (OR 7.0, 95% CI 1.5 to 31.8) and beta-blockers (OR 3.4, 95% CI 1.0 to 11.5) were associated with a CCD at follow-up. Higher age and longer symptom duration were highly correlated and were both associated with a CCD at follow-up.

Conclusions The presence of CCD in AS is in part dynamic and associated with both AS and non-AS characteristics. Our results suggest that patients especially prone to present with CCDs are older men with a previous CCD, longer symptom duration, higher AS disease activity, a history of anterior uveitis and medication reflecting cardiovascular disease.

  • ankylosing spondylitis
  • spondyloarthritis
  • cardiovascular disease

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Presented at Preliminary results have been presented as abstract/poster at EULAR in Amsterdam in 2018, at the 11th International Congress on Spondyloarthritides in Gent in 2018, and at the Swedish Rheumatology Meeting in Uppsala in 2018.

  • Contributors KB contributed to the data acquisition of the ECG characteristics at follow-up, analysis and interpretation of data, and drafting the first version of the manuscript. EK and AD recruited patients to the study and performed examinations and data acquisition at baseline and follow-up, respectively. HW contributed to the data acquisition of the ECG characteristics at baseline. LB contributed to the data acquisition of the ECG characteristics and interpretation of data. LJ contributed to the interpretation of data. HFdE conceived the study and contributed to the design of the study, acquisition and interpretation of data. EK, AD, HW, LB, LJ and HFdE revised the first version of the manuscript critically and participated in the editing until its final version. All authors agreed to be accountable for all aspects of the work and have read and approved the final manuscript.

  • Funding This study was supported by grants from the Health and Medical Care Executive Board of the Västra Götaland, Rune and Ulla Amlövs Foundation for Rheumatology Research, Göteborg’s Association Against Rheumatism, Swedish Rheumatism Association, Swedish Society of Medicine, Göteborg Medical Society, the Swedish state under the agreement between the Swedish government and the county councils, the ALF agreement (ALFGBG-141111, ALFGBG-430851, ALFGBG-678731), Controlling Chronic Inflammatory Diseases with Combined Efforts (COMBINE), and the Margareta Rheuma research foundation.

  • Competing interests LJ has received advisory board fees from Eli Lilly, Pfizer and Novartis. HFdE has received advisory board fees from Sandoz, AbbVie and Novartis, and unrestricted grant from Novartis.

  • Patient and public involvement statement One trained patient research partner from the Swedish Rheumatism Association participated in the planning of the study and contributed with comments on the study protocol and the written information to the patients.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Regional Ethics Committee, Gothenburg, Sweden, and carried out in compliance with the Helsinki Declaration. All patients gave their written informed consent to participate both at baseline and at follow-up.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data sets generated and/or analysed during the present study are not publicly available due to the General Data Protection Regulation, but at limited and fully anonymised data set that support the main analyses is available upon reasonable request.

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