Assessment of the right ventricular-pulmonary circulation unit during stress in ankylosing spondylitis and psoriatic arthritis patients

Cardiopulmonary complications are common in ankylosing spondylitis (AS) and arthritis psoriatica (APs), which have an unfavourable impact on mortality and quality of life. APs may be connected with pulmonary hypertension, while AS is linked to interstitial lung disease and chest wall restriction.

We aimed to assess the response of the pulmonary circulation unit during stress in AS and APs patients.

A total of 71 patients were enrolled in the study: 28 of them had AS (age 50.8±11.8 years), 17 APs (age 52.1±13.5 years), and 26 were healthy individuals (age 54.23±9.9 years). To 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.

AS patients had significantly higher pulmonary artery systolic pressure (PASP; AS: 32.6±16.8 mmHg, APs: 21.6±12.7 mmHg, p<0.05) and pulmonary vascular resistance (PVR; AS: 1.3±0.4 WU, PsA: 1.1±0.3 WU, p<0.05) at maximal workload, while the right ventricular-pulmonary arterial (RV-PA) coupling at peak stress was higher in APs patients (AS: 1.2±0.6 mm/mmHg, PsA: 1.8±1.1 mm/mmHg, p<0.05). Comparing to the control group, AS and PsA patients had significantly higher resting PASP (control: 12.6±6.4 mmHg; AS: 22.8±7.6 mmHg, p<0.001; PsA: 21.4±7.0 mmHg, p<0.001), lower resting RV-PA coupling (control: 2.7±1.4 mm/mmHg; AS: 1.3±0.4, p<0.001; PsA 1.3±0.4 mm/mmHg, p<0.001), and higher peak PVR (control: 0.6±0.4 WU; AS: 1.3±0.4, p<0.001; PsA: 1.1±0.3 WU, p<0.005). One-way analysis of variance of the three groups also showed significant differencies in the resting PASP (p<0.001), peak PASP (p<0.05), resting RV-PA coupling (p<0.001), peak PVR (p<0.001).

Stress echocardiography is a promising, radiation-free method for assessing the subclinical cardiopulmonary changes among AS and PsA patients. The changes of PVR during stress may highlight the pulmonary complications in the subclinical stage.

Type of funding sources: None.