Scoliosis was associated with altered cardiac function and an increase in cardiac events among adults in the U.K. Biobank, researchers found.

Compared with peers without scoliosis, those with such sideways spinal curvature exhibited a greater lifetime risk of major adverse cardiovascular events (MACE; HR 1.45, P<0.001), driven by heart failure (HR 1.58, P<0.001) and atrial fibrillation (HR 1.54, P<0.001), reported Kathryn McGurk, PhD, a cardiovascular geneticist at Imperial College London, and colleagues.

People with scoliosis also had a greater lifetime risk of altered diastolic strain in terms of increased radial (-5.08 vs -5.64, P<0.05) and decreased longitudinal (1.45 vs 1.66, P<0.05) peak diastolic strain rates on cardiac MRI, as well as cardiac compression of the top and bottom of the heart and elongation of the sides from surface-to-surface analysis.

“These findings suggest that early medical intervention in patients with scoliosis through surgery may decrease the risk of future MACEs, however, future validation of this finding is needed in a scoliosis case cohort. It may be possible that scoliosis develops secondary to other diseases that could also increase the risk of MACEs,” the authors noted in Open Heart.

“Further research is required to follow up the role of scoliosis in cardiac manifestations in a clinical setting,” they added.

Scoliosis is the most common spinal deformity. This condition can be traced to multiple etiologies and is most commonly idiopathic in children and teenagers. In adults, however, new-onset scoliosis often results from degenerative disease in the lower back starting around age 65, according to the American Association of Neurological Surgeons.

McGurk’s group said that degenerative scoliosis is observed in 68% of adults over 60.

In children and adults alike, mild spinal curvature may require periodic observation, while more severe cases may require bracing and surgery.

Based on their observations, McGurk and colleagues suggested that the abnormal curvature of the spine in scoliosis increases mechanical constraint on the heart without altering blood flow.

“This altered cardiac strain may be explained by the deformity of the thoracic cage in scoliosis limiting cardiac diastolic movement. The mechanical abnormalities of the thoracic spine as well as the impact on the pulmonary system may be the primary cause of the heart involvement,” the authors wrote.

“Secondary involvement via altered pulmonary hemodynamics may be possible, where spinal curvature impacts pulmonary pressures leading to pulmonary hypertension. Likewise, direct compression of the myocardium could occur in conjunction with pulmonary involvement,” they added.

The study relied on the U.K. Biobank database of over 500,000 adults recruited across the U.K. from 2006 to 2010. There were 4,095 participants with a record of scoliosis, representing 0.8% of the entire cohort.

Of the scoliosis group, just 0.2% had congenital scoliosis and 0.6% had childhood scoliosis; the rest reported scoliosis due to other causes later in life.

People with scoliosis tended to be older (59.4 vs 56.5 years, P<0.01) and were more likely to be women (69% vs 55%, P<0.01) compared with other study participants. They also had an increased burden of heart failure, valve disease, hypercholesterolemia, and hypertension, adjusted for age and sex.

Nevertheless, lifetime risk analysis showed that participants with scoliosis lived significantly longer lives when compared with the rest of the population, McGurk and colleagues reported.

They noted that scoliosis patients did undergo significantly fewer cardiac MRI scans for analysis versus the no-scoliosis group. It was possible that selection bias precluded those with more severe scoliosis from agreeing to cardiac MRI.

“Adaptations may be required to allow patients with scoliosis to undergo MRI scans more comfortably and to further assess any alteration in cardiac function in patients with scoliosis,” the authors suggested.

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