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Novel imaging modalities in detection of cardiovascular involvement in ankylosing spondylitis
Demet Ozkaramanli Gur1, Derya Necmiye Ozaltun2, Savas Guzel3
1a Cardiology Department , Namik Kemal University , Tekirdag , Turkey.
Insights
Early cardiovascular impairment in ankylosing spondylitis (AS) is detectable using advanced echocardiography. Strain imaging effectively identifies left ventricle (LV) and aortic dysfunction, even before structural changes appear.
Area of Science:
- Cardiology
- Rheumatology
- Medical Imaging
Background:
- Cardiovascular involvement in ankylosing spondylitis (AS) often goes undiagnosed due to reliance on morphological changes.
- Early detection of cardiac impairment in AS is crucial for timely intervention.
Purpose of the Study:
- To assess the utility of tissue Doppler and strain imaging for evaluating left ventricle (LV) and proximal aorta in AS patients.
- To investigate the role of cardiac fibrosis biomarkers, galectin-3 (Gal-3) and soluble suppression-of-tumorogenicity-2 (sST2), in early cardiovascular impairment in AS.
Main Methods:
- Prospective study involving 75 AS patients and 30 healthy controls.
- Echocardiographic assessment included layer-specific LV strain/strain rates and proximal aorta strains.
- Measured central pulse wave velocity (cPWV), hsCRP, Gal-3, and sST2 levels.
Main Results:
- AS patients exhibited elevated hsCRP and sST2 levels compared to controls.
- Reduced LV longitudinal strain, myocardial strain rates, and aortic transverse strains were observed in AS patients.
- AS was independently associated with LV dysfunction and aortic impairment, identified by strain imaging parameters.
Conclusions:
- Functional cardiovascular impairment occurs early in ankylosing spondylitis.
- Strain imaging is a valuable tool for detecting early cardiac and aortic involvement in AS.
- sST2 may link inflammation and fibrosis in AS pathogenesis.
Objectives:
The diagnosis of cardiovascular involvement in ankylosing spondylitis (AS) is usually delayed since conventional echocardiography relies mainly on the morphological alterations. The aim of this study was to evaluate the role of echocardiographic methods such as tissue Doppler and strain imaging of left ventricle (LV) and proximal aorta; and concentrations of biomarkers of cardiac fibrosis such as galectin-3 (Gal-3) and soluble suppression-of-tumorogenicity-2 (sST2) in determining early cardiovascular impairment in AS.
Design:
In this prospective study of 75 AS and 30 healthy subjects (mean age 41.7 ±10.1 years; 37.3% female), we determined layer-specific strain and strain rates in longitudinal, circumferential and radial axes for LV as well as transverse and longitudinal strains of proximal aorta; central pulse wave velocity(cPWV); plasma high sensitivity C-reactive protein(hsCRP), Gal-3 and sST2 levels.
Results:
Patients with AS had increased levels of hsCRP and sST2 when compared to healthy controls. cPWV, E and e' velocities; longitudinal strain and strain rates at all myocardial layers; and transverse strains of both anterior and posterior aortic walls were reduced in AS patients. Gal-3 levels with strain and strain rates at circumferential and radial axes were similar between the groups. Among all echocardiographic and clinical parameters, AS was independently associated with LV dysfunction (expressed by longitudinal strain of LV) and aortic impairment (expressed by transverse strain of anterior wall).
Conclusions:
This study demonstrates that functional impairment in AS occurs early in the disease course and strain imaging is an effective tool in discriminating involvement. sST2 may represent the link between inflammation and fibrosis in AS.
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