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The Role of the Three-Dimensional Systolic Dyssynchrony Index and Autonomic Dysfunction Parameters in Detecting
Kutluhan Eren Hazir1, Öner Özdoğan2, Ali Kemal Çabuk2
1Department of Cardiology, Şanlıurfa Siverek State Hospital, Şanlıurfa, Turkey.
Insights
Ankylosing spondylitis patients show increased heart mechanical dyssynchrony, detectable by 3D echocardiography, even with normal ejection fraction. This subclinical cardiac issue is linked to disease activity.
Area of Science:
- Cardiology
- Rheumatology
- Medical Imaging
Background:
- Ankylosing spondylitis (AS) is linked to higher cardiovascular risks, often undetected.
- Subclinical cardiac dysfunction is a concern in AS patients.
Purpose of the Study:
- To investigate subclinical cardiac dysfunction in AS using 2D/3D echocardiography.
- To explore the relationship between cardiac dysfunction, autonomic dysfunction, and disease activity in AS.
Main Methods:
- Cross-sectional study of 50 AS patients and 31 controls.
- Utilized 2D/3D echocardiography (echocardiography), 24-hour Holter monitoring (heart rate variability), and disease activity assessment (Bath AS Disease Activity Index [BASDAI]).
Main Results:
- AS patients had significantly higher 16-Segment Systolic Dyssynchrony Index (16-SDI) than controls (p < 0.001), indicating increased ventricular mechanical dispersion.
- Heart rate variability indices were lower in AS patients (p < 0.01).
- BASDAI positively correlated with 16-SDI (r = 0.650, p < 0.001) and predicted mechanical dispersion.
Conclusions:
- AS patients exhibit subclinical left ventricular mechanical dyssynchrony detectable by 3D echocardiography, despite normal ejection fraction.
- This dyssynchrony is independently associated with AS disease activity, suggesting a link to inflammation.
- 3D echocardiography-derived mechanical dyssynchrony may serve as an early marker for subclinical cardiac issues in AS.
Objective:
Ankylosing spondylitis (AS) is associated with an increased risk of cardiovascular complications, often subclinical. This study aimed to comprehensively investigate subclinical cardiac dysfunction using two- and three-dimensional echocardiography (2DE, 3DE) and its relationship with autonomic dysfunction parameters and disease activity in AS patients without overt heart disease.
Methods:
This cross-sectional study included 50 AS patients and 31 age- and sex-matched healthy controls. All participants underwent 2DE, 3DE (for EF, left ventricular systolic dyssynchrony index, 16-Segment Systolic Dyssynchrony Index [16-SDI]), 24-hour Holter monitoring (for heart rate variability [HRV]), clinical evaluation (Bath AS Disease Activity Index [BASDAI]), and biochemical testing.
Results:
Conventional systolic functions (2DE/3DE LVEF) was comparable between groups; however, AS patients exhibited significantly higher 16-SDI values compared with controls (median 3.48% [2.4-5.2] vs. 1.64% [1.3-2.4], p < 0.001), indicating greater ventricular mechanical dispersion despite preserved ejection fraction. HRV indices including standard deviation of all normal-to-normal intervals (SDNN), triangular index, and low frequency (LF)/high frequency (HF) ratio, showed relatively lower values in AS patients (p < 0.01 for all), although within generally accepted physiological ranges. BASDAI correlated positively with 16-SDI (r = 0.650, p < 0.001) and remained an independent predictor of increased mechanical dispersion in multivariable analysis (β = 1.98, 95% CI 0.98-2.98; p < 0.001).
Conclusion:
AS patients demonstrate a significant subclinical shift toward increased left ventricular mechanical dyssynchrony detectable by 3DE despite normal ejection fraction. This alteration is independently associated with disease activity, suggesting a potential link with systemic inflammatory burden and early myocardial mechanical impairment. These findings indicate that 3DE-derived mechanical dyssynchrony may represent an early and sensitive marker of subclinical cardiovascular involvement in selected AS patients, warranting confirmation in longitudinal studies.
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