REPLY
HLA-B27-Associated Cardiac Disease
Lennart Bergfeldt, MD, PhD
1 May 1998 | Volume 128 Issue 9 | Page 781
IN RESPONSE:
I appreciate Dr. Arnason's letter and his suggestion that transesophageal echocardiography may be more sensitive than transthoracic echocardiography for evaluating cardiac manifestations related to the HLA-B27-associated disease process. The increased sensitivity is analogous to what has been proven for bacterial endocarditis. In the hands of Dr. Arnason and his colleagues, the transesophageal echocardiography-derived observations regarding the subaortic structures also seemed to be specific for patients with ankylosing spondylitis [1]. If these results can be confirmed and extended, they may also expand the proportion of HLA-B27-positive patients with disease manifestations related to this genetic trait beyond the present Figure of 20% to 25%.
I would, however, like to stress the fact that transesophageal echocardiography is still a "research tool" for this indication. Much work, such as longitudinal studies, needs to be done to prove the clinical value of repeated evaluations with this test, which was performed in only a minority of Arnason and colleagues' cohort of patients with ankylosing spondylitis.
For pathophysiologic reasons discussed in my review, I doubt that Arnason and colleagues' observations will have any predictive value with regard to the development of aortic valve insufficiency or atrioventricular conduction block.
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Author and Article Information
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Karolinska Hospital; S-171 76 Stockholm, Sweden
1. Arnason JA, Patel AK, Rahko PS, Sundstrom WR. Transthoracic and transesophageal echocardiographic evaluation of the aortic root and subvalvular structures in ankylosing spondylitis. J Rheumatol. 1996; 23:120-3.
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