Ayse Dicle Turhanoglu

Left ventricular wall function abnormalities in patients with ankylosing spondylitis evaluated by gated myocardial perfusion scintigraphy

BACKGROUND Ankylosing spondilitis (AS) is a chronic inflammatory disease with prominent inflammation in joints and extraarticular organs. AS patients have approximately two times more risk of mortality than the normal population. One reason for this increase in mortality is increased cardiovascular risk. In this study, we have aimed to evaluate myocardial perfusion and left ventricular function using (99m)Tc-MIBI gated myocardial perfusion single photon emission computed tomography (SPECT). MATERIAL AND METHODS The study group consisted of 28 AS patients (19 men, 9 women), and mean age 39.46±10.98 years. All patients underwent (99m)Tc-MIBI gated myocardial perfusion SPECT with the same day protocol. RESULTS We detected various risk factors including smoking habits in 12, family history of cardiovascular disease in 12, hypertension in 3, hyperlipidemia in 9 patients. We performed a myocardial perfusion SPECT for each patient and found normal perfusion pattern in SPECT images. Out of 28 patients, eight patients had normal perfusion but wall motion abnormalities. CONCLUSION We detected that myocardial perfusion is preserved in the patients with AS. However, left ventricular wall motion abnormalities are seen. We concluded that ankylosing spondylitis may be associated with microvascular dysfunction and gated myocardial perfusion scintigraphy could be valuable in AS patients for the evaluation of LV function even if the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score are low and the disease duration shorter.

Ultrasonographic Assessment of the Distal Femoral Cartilage Thickness in Patients with Homozygous Sickle Cell Disease.

Objective To compare the distal femoral cartilage thickness of patients with sickle cell disease (SCD) with those of healthy subjects using ultrasonography. Methods The study comprised 30 patients with SCD (16 male, 14 female; mean age, 30.1 years) and 30 age- and sex-matched healthy subjects. Demographic features and medications of the patients were recorded. With the knees held in maximum flexion, the femoral cartilage thickness was measured bilaterally with a 7- to 12-MHz linear probe. Using ultrasonography, 3 midpoint measurements were taken from both knees: lateral femoral condyle (LFC), intercondylar area (ICA), and medial femoral condyle (MFC). Results Patients with SCD had thinner femoral cartilage thickness values at LFC (P = 0.004), at MFC (P = 0.000), and ICA (P = 0.002) when compared with those of the healthy subjects. Patients with SCD also had lower Hb levels (P = 0.000) levels. Weak positive correlations were determined between Hemoglobin (Hb) levels and ultrasonographic measurements in the SCD group at MFC (r = 0.331, P = 0.010), and ICA (r = 0.289 , P = 0.025 ). Low levels of Hb seem to affect the femoral cartilage thickness. Conclusion These preliminary findings of decreased femoral cartilage thickness in SCD patients should be complemented with future studies. The possibility of early knee joint degeneration and eventual osteoarthritis in SCD should be kept in mind.

Does transcutaneous nerve stimulation have effect on sympathetic skin response

OBJECTIVE This study examined the effects of transcutaneous electrical nerve stimulation (TENS) on the sympathetic nerve system by sympathetic skin response test. METHODS Fifty-five healthy volunteers received either: (i) 30minutes TENS (25 participants) (ii) 30minutes sham TENS (30 participants) and SSR test was performed pre- and post-TENS. The mean values of latency and peak-to-peak amplitude of five consecutive SSRs were calculated. RESULTS A significant amplitude difference was found between TENS and sham TENS group both in right and left hand (p=0.04, p=0.01, respectively). However there was no significant latancy difference between two groups (p>0.05 ). CONCLUSION TENS has an inhibitory effect on elicited SNS responses when compared with sham TENS control group.

Assessment of the Anterior Talofibular Ligament Thickness in Patients with Chronic Stroke: An Ultrasonographic Study

Background: Patients with equinovarus deformity have an increased risk of fall and ankle ligament injury, because of inappropriate prepositioning of the ankle at the end of the swing phase, and inadequate leg and ankle stability during the stance phase. Accordingly, the aim of this study is to compare anterior talofibular ligament (ATFL) thickness of chronic stroke patients with that of healthy individuals using ultrasonography. Methods: This was a case-control study conducted in a university hospital between July 2015 and July 2016. We included 38 patients [study group; mean age, 59.0 ± 11.1 years; mean body mass index (BMI), 25.4 ±4.3 kg/m2] and a control group of age-, sex-, and BMI-matched healthy individuals. Demographic and clinical characteristics of the patients (i.e., age, weight, height, Brunnstrom motor recovery stage, Functional Ambulation Scale, Ashworth Scale, and duration of hemiplegia) were recorded during their visits. Furthermore, ultrasound image of the ATFL was obtained from each ankle. The thickness of the ATFL was measured at the midpoint of the ligament between the attachments on the lateral malleolus and the talus using ultrasonography. Results: In the study group, the mean thickness of the ATFLs of the affected side (2.75 ± 0.41 mm) was thicker than both the unaffected side (2.42 ± 0.30 mm) and the healthy controls (2.35 ± 0.19 mm; p = 0.007, p < 0.001, respectively). No differences were seen between the two sides of the control group. Conclusion: Chronic stroke patients have a thicker ATFL on both the affected and unaffected sides, compared with healthy individuals. This architectural feature of the ATFL may be a result of equinovarus deformity together with spastic muscles. For this reason, early treatment of deformed ligaments and spastic muscles is needed to prevent equinovarus deformity in patients with stroke.

Ultrasonography Can Be Used to Assess Phalanx Fractures

To the Editor: A 27-year-old man presented with trauma to the ring finger of the left hand, which had occurred one week previously. Pain had suddenly started after he experienced a crush injury during a football game. On physical examination, palpation of the fourth distal phalanx was painful. He could not voluntarily extend the distal phalanx of the fourth digit and he had local swelling. Radiologic evaluation showed a displaced intra-articular fracture of the fourth distal phalanx (Fig. 1A). Ultrasonography (US) was selected as an additional method of assessment and the US image confirmed an avulsed fragment from the distal interphalangeal joint (Fig. 1B, C). The patient was

SAT0173 Assessment of Left Ventricular Dyssynchrony in Patients with Familial Mediterranean Fever

Background Familial Mediterranean fever (FMF) is a disease characterized by recurrent and sustained increased inflammatory activity. Various clinical and subclinical cardiovascular involvements have been reported in FMF patients. However, there is considerable lack of evidence regarding contraction synchrony in FMF. Objectives We aimed to study the left ventricular contraction synchrony in FMF patients with narrow QRS and normal EF. Methods Seventy patients with FMF and 35 age- and sex- matched control subjects were included the study. Left ventricular dyssynchrony was investigated by color coded tissue Doppler imaging. Results In the FMF group, the mean high-sensitive C-reactive protein (hs-CRP) values were significantly higher, compared with the controls (p<0.01). According to the tissue Doppler measurements, E/Em value exhibited statistically significant increase in FMF patient and mean Em value were found to be significantly low (p<0.01). In the control group, two patients had diastolic dysfunction, whereas in the FMF group there were 23 (%46) patients with diastolic dysfunction. LV systolic dyssynchrony parameters including Ts-SD-12, Ts-12, Ts-SD-6, and Ts-6 were found to be higher in FMF group when compared to controls (p<0.01). In addition to that, number of the patients with ventricular dyssynchrony (a Ts-SD-12>34.4 ms) were higher in the FMF group than the control group (34.2±6.9 vs. 24.7±5.8; p<0.01). Ventricular dyssynchrony was detected in all FMF patients with diastolic dysfunction. In the correlation analysis, systolic dyssynchrony parameters were found to be correlated with hs-CRP, E/Em, and Em (p<0.01). Conclusions We found out that in FMF patients with normal EF and narrow QRS, left ventricular systolic dyssynchrony is an early manifestation of heart involvement and may be coexisted with by diastolic dysfunction. References Kiris A, Karkucak M, Karaman K, Kiris G, Capkin E, Gokmen F, et al. Patients with ankylosing spondylitis have evidence of left ventricular asynchrony. Echocardiography. 2012 Jul;29(6):661-7. Lachmann HJ, Sengul B, Yavuzsen TU, Booth DR, Booth SE, Bybee A, et al. Clinical and subclinical inflammation in patients with familial Mediterranean fever and in heterozygous carriers of MEFV mutations. Rheumatology (Oxford). 2006 Jun;45(6):746-50. Korkmaz C, Ozdogan H, Kasapcopur O, Yazici H. Acute phase response in familial Mediterranean fever. Ann Rheum Dis. 2002 Jan;61(1):79-81. Tavil Y, Ureten K, Ozturk MA, Sen N, Kaya MG, Cemri M, et al. The detailed assessment of left and right ventricular functions by tissue Doppler imaging in patients with familial Mediterranean fever. Clin Rheumatol. 2008 Feb;27(2):189-94. Baysal T, Peru H, Oran B, Sahin TK, Koksal Y, Karaaslan S. Left ventricular diastolic function evaluated with tissue Doppler imaging in children with familial Mediterranean fever. Clin Rheumatol. 2009 Jan;28(1):23-8. Kalkan GY, Bayram NA, Erten S, Keles T, Durmaz T, Akcay M, et al. Evaluation of left ventricle function by strain imaging in patients with familial Mediterranean fever. Echocardiography. Oct;27(9):1056-60. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1345

AB0952 Subclinical Left Ventricular Dysfunction in Patients with Ankylosing Spondylitis without Clinically Evident Cardiovascular Disease: A Two-Dimensional Speckle Tracking Echocardiographic Study

Background Cardiac involvement is common in ankylosing spondylitis (AS), which has not been previously evaluated by using speckle tracking echocardiography (STE). Objectives The objectives of this study were to evaluate the left ventricle (LV) systolic strain by STE in order to provide the subclinical myocardial dysfunction in patients with AS and to examine the relationship between LV systolic strain and disease activity indices. Methods A total of 26 patients with AS without clinically evident cardiovascular disease and 26 age-,sex-,and BMI-matched healthy controls were included in the study. Bath AS disease activity index, Bath AS fuctional index, Bath AS metrology index and Bath AS radiologic index were used as clinical indices. Conventional echocardiography, tissue Doppler imaging, color tissue Doppler derived strain/strain rate echocardiographic imaging were performed by a single cardiologist using a 2.5–3.5 MHz transducer and Vingmed System 7 (Vivid 7 Pro; Horton, Norway). All data were transferred to a workstation for further offline analysis (EchoPAC 6.1; GE Vingmed Ultrasound AS). For left ventricle color tissue Doppler dynamic images were obtained from from LV apical 4-, 3- and 2-C (chamber) views. Results There were no significant differences in baseline demographic characteristics and cardiovascular risk factors between the patients and the controls. There were no significant differences between patients and controls in terms of left ventricle diameters, ejection fraction, posterior wall thickness, interventriculer septum wall thickness, mitral deceleration time and systolic myocardial flow velocity (p>0.05). AS patients were observed to have statistically significantly lower left ventricule peak longitudinal and global strain/strain rate values in the 4C, 3C, and 2C views compared with the controls (p>0.05). In addition, we detected no correlation in left ventricule global strain values and AS clinical indices values (p>0.05). Conclusions Myocardial systolic function assessed by STE, which is a sensitive marker of ventricular dysfunction is impaired in AS. References Teske AJ, De Boeck BW, Melman PG, Sieswerda GT, Doevendans PA, Cramer MJ. Echocardiographic quantification of myocardial function using tissue deformation imaging, a guide to image acquisition and analysis using tissue Doppler and speckle tracking. Cardiovasc Ultrasound 2007;5:27. Schiller NB, Shah PM, Crawford M, et al: American Society of Echocardiography committee on standards, subcommittee on quantitation of two-dimensional echocardiograms: Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiography 1989;2:358–367. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1961