Abstract Background Ankylosing Spondylitis (AS) is a chronic inflammatory disease of unknown etiology, initially affecting the sacroiliac joints and progressively involving the axial skeleton over time (1,2). Cardiovascular complications are reported in 2-30% of AS cases and represent the leading cause of mortality in this population (3,4). Although cardiac complications are common, traditional clinical assessment methods are insufficient for the early detection of cardiac dysfunction in AS patients. Purpose This study aims to evaluate subclinical cardiac dysfunction in AS patients using two dimensional (2D) and three dimensional (3D) echocardiography parameters and to detect its association with conduction defects and autonomic dysfunction. Methods The study included 50 AS patients and 31 age- and sex-matched healthy controls, all with preserved left ventricular ejection fraction (LVEF) as assessed by 2D and 3D echocardiography. Biochemical markers, including hemogram, C-reactive protein (CRP), brain natriuretic peptide (BNP), and low-density lipoprotein (LDL) were measured in both groups. Standard electrocardiographic parameters and 2D echocardiography parameters including diastolic dysfunction parameters were evaluated. Left ventricular (LV) end-diastolic and end-systolic volumes, LVEF, and 16-segment systolic dyssynchrony indices (SDI) were calculated by 3D echocardiography. A 24-hour ambulatory ECG monitoring was used to obtain the Triangular Index, SDNN, LF/HF, and average heart rate. These data were analyzed in relation to the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) , which reflects disease activity and has prognostic value in patients with AS. Results There were no statistically significant differences between the AS and control groups regarding 2D LVEF (60.0 vs. 60.0, p=0.119), 3D LVEF (58.97±3.18 vs. 59.6±2.50, p=0.368), and QRS duration (87.0 vs. 88.0, p=0.416). However, the AS group exhibited significantly higher LDL (135.4±31.1 vs. 108.5±21.0, p0.001), BNP (33.2 vs. 15.4, p=0.001), CRP (11.2 vs. 1.0, p0.001), left atrial size (33.0 vs. 31.0, p=0.005), and 16-SDI (3.5 vs. 1.6, p0.001). Conversely, the E/A ratio (1.2 vs. 1.3, p=0.012), HRV-Ti (25.0 vs. 37.0, p0.001), SDNN (112.5 vs. 142.0, p0.001), and LF/HF ratio (1.1±0.4 vs. 1.3±0.3, p=0.004) were significantly lower in AS patients. Statistically significant variables are summarized in Table 1. Furthermore, in the AS group, 16-SDI showed a strong positive correlation with BASDAI (r=0.650, p0.001) (Figure 1). Conclusion This is the first study to demonstrate significantly increased 3D 16-SDI in AS patients compared to healthy controls, despite no differences in QRS duration, 2D LVEF, or 3D LVEF. Moreover, higher 16-SDI values correlated with increased BASDAI. The concomitant impairment in heart rate variability and elevated BNP levels suggest that increased 16-SDI may serve as a potential early marker of subclinical cardiac dysfunction in AS patients.
Hazir et al. (Sat,) studied this question.