Patients with Ankylosing Spondylitis Have Evidence of Left Ventricular Asynchrony

Abstract

Ankylosing spondylitis (AS) is a chronic inflammatory disease that often leads to cardiovascular complications including aortic regurgitation and conduction disturbances. Left ventricular (LV) systolic asynchrony is defined as loss of the simultaneous peak contraction of corresponding cardiac segments. The aim of this study was to evaluate LV systolic asynchrony noninvasively in patients with AS by using tissue synchrony imaging (TSI). Asynchrony was evaluated in 77 AS patients (61 male, mean age 36.4 ± 10 years) and 40 controls (35 male, mean age 39.1 ± 8.2 years). All study population underwent a comprehensive echocardiographic evaluation including TSI. The time to regional peak systolic velocity (Ts) during the ejection phase in LV was measured from TSI images by the six-basal and six-midsegmental model, and four TSI parameters of systolic asynchrony were computed. The baseline demographic and echocardiographic characteristics were similar between the patients enrolled and controls. All TSI parameters of LV asynchrony were prolonged in patients with AS compared to controls: the standard deviation (SD) of the 12 LV segments Ts (39.6 ± 19.6 vs. 24.7 ± 11.6, P < 0.001); the maximal difference in Ts between any 2 of the 12 LV segments (122.1 ± 52.9 vs. 82.2 ± 38.6, P < 0.001); the SD of the six basal LV segments (33.5 ± 20.2 vs. 23 ± 13.3, P = 0.008); and the maximal difference in Ts between any two of the six basal LV segments (84.6 ± 48.1 vs. 60.4 ± 34.6, P = 0.008). The asynchrony parameters were significantly correlated with index of myocardial performance (Tei index) and peak systolic mitral annular velocity. TSI showed presence of LV systolic asynchrony in patients with AS which may account for the cardiovascular complications of AS.