Rethinking valve regurgitation in ankylosing spondylitis: aortic regurgitation is uncommon rather than lethal

Although aortic regurgitation (AR) has historically been regarded as a serious complication of ankylosing spondylitis, it is rarely observed in clinical practice. This study evaluated the prevalence and severity of valvular regurgitation in ankylosing spondylitis. A total of 388 consecutive, tumor necrosis factor inhibitor-naïve ankylosing spondylitis patients were enrolled. All underwent echocardiography to assess valvular regurgitation, stenosis, and calcification, alongside collection of clinical data. The mean age of the patients with ankylosing spondylitis was 37.2 ± 13.6 years with a disease duration of 91.2 ± 99.1 months. Moderate to severe valvular regurgitation was found in five patients with ankylosing spondylitis [1 with severe AR, 2 with moderate AR, 2 with moderate mitral regurgitation (MR), and 1 with severe tricuspid regurgitation(TR)], but not in HC subjects (AR: p = 0.08; MR: p = 0.16; TR: p = 0.32). AR was detected in 0.8% patients with ankylosing spondylitis. Patients with an older age and a longer disease duration were prone to experiencing valvular regurgitation. Affected patients showed lower hemoglobin levels, higher erythrocyte sedimentation rate (ESR) levels, and increased left ventricular dimensions. Valvular regurgitation, particularly AR, is uncommon in ankylosing spondylitis, and severe or life-threatening cases are rare.