Background/Purpose: Patients with ankylosing spondylitis (AS) are at increased risk for cardiovascular disease (CVD), although strategies to detect subclinical CVD are poorly characterized. The aim of this study was to assess left ventricular (LV) systolic and diastolic function by speckle tracking echocardiography (STE) to detect subclinical left ventricular dysfunction in patients with AS without known CVD. We also tested if CVD activity in AS was associated with lower LV systolic function independently of traditional cardiovascular risk factors.

Methods: Two-dimensional, Doppler, tissue Doppler, and STE assessments were performed in 44 patients with AS (Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP) ≥1.3), 20 patients with inactive disease (ASDAS-CRP<1.3), and 26 healthy controls. AS diagnoses fulfilled the modified New York criteria. None of the enrolled patients or healthy individuals had known cardiac disease. LV systolic function was assessed by ejection fraction (EF) and global longitudinal strain (GLS). LV diastolic function was assessed by septal e^’, lateral e^’, left atrial maximum volume index (LAVI), average E/e^’ ratio, and peak tricuspid regurgitation velocity.

Results: Mean patient age was 31-35 years with 91-95% males in all groups. The average disease duration for patients with active and inactive AS was 9 years. LV EF was normal in all patients and controls and did not differ between groups (p ≥ 0.43). GLS was significantly reduced in active AS patients compared with inactive AS patients (21.9 ± 2.02 vs 24.4 ± 2.73, p < 0.0001) and controls (21.9 ± 2.02 vs 24.0 ± 2.00, p = 0.0001). In multivariate analyses, active AS and increasing levels of disease activity by ASDAS-CRP score were associated with lower GLS after adjustment for other covariables that included age, sex, body mass index, systolic blood pressure, and disease duration. Septal e’ and lateral e’ were decreased in active AS patients compared with controls (9.30 ± 2.08 vs 10.5 ± 1.78, p = 0.01 and 12.9 ± 2.95 vs 14.9 ± 2.91, p = 0.007), respectively, but not inactive AS patients (p ³ 0.11). LAVI was not significantly higher in active AS patients versus controls or inactive AS patients (p ≥ 0.10). The average E/e^’ ratio was higher in active AS patients compared with controls (8.13 ± 1.97 vs 7.25 ± 1.10, p = 0.04) but not inactive AS patients (p = 0.27). GLS, septal e’ and lateral e’, LAVI, and average E/e^’ did not differ between inactive AS and controls (p =≥ 0.49). Tricuspid regurgitation did not differ among the three groups, and the velocity was far less than 2.8 m/s generally used as the cut-off for diagnosis of LV diastolic dysfunction.

Conclusion: GLS is significant reduced in Active AS patients compared with Inactive AS patients and healthy controls. Active AS is associated with lower LV systolic myocardial function despite normal LV EF. Patients with Active AS may also have impaired left ventricular diastolic function. Speckle tracking echocardiography may be a useful tool for early detection of impaired LV function in patients with AS. Disease activity in AS was associated with lower LV systolic function independently of traditional cardiovascular risk factors.

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluation-of-left-ventricular-systolic-and-diastolic-myocardial-function-in-patients-with-ankylosing-spondylitis-by-speckle-tracking-echocardiography/