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. 2021 Sep 24:8:719523.
doi: 10.3389/fcvm.2021.719523. eCollection 2021.

Valve Abnormalities, Risk Factors for Heart Valve Disease and Valve Replacement Surgery in Spondyloarthritis. A Systematic Review of the Literature

Hye-Sang Park  1 , Ana Laiz  2   3 , Jesus Sanchez-Vega  4   5 , Petra Díaz Del Campo  6 , Maria Auxiliadora Martín-Martínez  6 , Mercedes Guerra-Rodríguez  6 , Hector Corominas  1   2   3
Affiliations

Valve Abnormalities, Risk Factors for Heart Valve Disease and Valve Replacement Surgery in Spondyloarthritis. A Systematic Review of the Literature

Hye-Sang Park et al. Front Cardiovasc Med. .

Abstract

Objective: Evaluate the evidence on the abnormalities of the aortic root and heart valves, risk and prognostic factors for heart valve disease and valve replacement surgery in spondyloarthritis. Methods: A systematic literature review was performed using Medline, EMBASE and Cochrane databases until July 2021. Prevalence, incidence, risk and prognostic factors for heart valve disease; dimension, morphology, and pathological abnormalities of the valves were analyzed. Patient characteristics (younger age, history of cardiac disease or longer disease duration) and period of realization were considered for the analysis. The SIGN Approach was used for rating the quality of the evidence of the studies. Results: In total, 37 out of 555 studies were included. Overall, the level of evidence was low. The incidence of aortic insufficiency was 2.5-3.9‰. Hazard Ratio for aortic insufficiency was 1.8-2.0. Relative risk for aortic valve replacement surgery in ankylosing spondylitis patients was 1.22-1.46. Odds ratio for aortic insufficiency was 1.07 for age and 1.05 for disease duration. Mitral valve abnormalities described were mitral valve prolapse, calcification, and thickening. Aortic valve abnormalities described were calcification, thickening and an echocardiographic "subaortic bump." Abnormalities of the aorta described were thickening of the wall and aortic root dilatation. The most common microscopic findings were scarring of the adventitia, lymphocytic infiltration, and intimal proliferation. Conclusions: A higher prevalence and risk of aortic valve disease is observed in patients with ankylosing spondylitis. Studies were heterogeneous and analysis was not adjusted by potential confounders. Most studies did not define accurate outcomes and may have detected small effects as being statistically significant.

Keywords: HVD (heart valve disease); cardiac image; echocardiography; epidemiology; psoriatic arthritis; spondyloarthritis; systematic (literature) review; valve (lesions, repair, replacement).

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Conflict of interest statement

AL has received speaker fees/honoraria from Abbvie, Lilly, Novartis, Pfizer, and UCB. HC has received speaker fees/honoraria from BMS, Gebro, MSD, Lilly, Novartis, Pfizer, Roche, Sanofi, and UCB and has participated in consulting for Abbvie, Amgen, Biogen, Celgene, Gilead, Kern, Pfizer, and Sanofi. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow chart.
See this image and copyright information in PMC

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