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Peer-reviewedCC BYCardiology research

Left Ventricular Myocardial Deformation Abnormalities in Ankylosing Spondylitis (Radiographic Axial Spondyloarthritis): Association With Disease Severity Assessed by Two-Dimensional Speckle-Tracking Echocardiography

  • Muhammad Saad Reihan1,2
  • Mohammed Moanes Mohammed Mohyeldin3,4
  • Ahmed Al-Habbaa3
  • Mohamed Sayed Bashandy1
  • Husna Irfan Thalib5
  • Ibrahim Fawzy Ezz6
  • Mohamed Al-Adl Ali Ali6
  • Abdelwahab Nasrat Bayoumy6
  • Mohamad Abdel-Moez Ali6
6 affiliations
  1. 1Cardiology Department, Faculty of Medicine, Al-Azhar University, New Damietta, Egypt
  2. 2Department of Internal Medicine, General Medicine Practice Program, Batterjee Medical College, Jeddah, Saudi Arabia
  3. 3Cardiology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
  4. 4Hayat National Hospitals, Jazan, Saudi Arabia
  5. 5General Medicine Practice Program, Batterjee Medical College, Jeddah, Saudi Arabia
  6. 6Department of Rheumatology and Rehabilitation, Al-Azhar University, Faculty of Medicine, Cairo, Egypt
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Abstract

Background: Ankylosing spondylitis (AS), also termed radiographic axial spondyloarthritis (r-axSpA) under current Assessment of SpondyloArthritis international Society (ASAS) nomenclature, is a chronic inflammatory disorder associated with an increased risk of cardiovascular involvement, including subclinical myocardial dysfunction. Conventional echocardiography often fails to detect early myocardial abnormalities despite preserved left ventricular systolic function. Two-dimensional speckle-tracking echocardiography (2D-STE) enables sensitive assessment of myocardial deformation through global longitudinal strain (GLS), facilitating the early detection of subclinical cardiac involvement. This study aimed to evaluate left ventricular myocardial deformation in patients with AS using 2D-STE and investigate its relationship with disease severity and duration.

Methods: This cross-sectional observational study included 35 patients with AS diagnosed according to the Modified New York criteria. All participants underwent comprehensive clinical evaluation, laboratory investigations, conventional transthoracic echocardiography, and 2D-STE. Disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS). Radiographic disease severity was determined using the modified New York sacroiliitis grading system. Correlations between myocardial deformation parameters, radiographic severity, and disease duration were analyzed using Pearson’s correlation coefficient.

Results: The study population had a mean age of 33.9 ± 7.3 years, and 68.6% were male. Conventional echocardiography demonstrated preserved left ventricular systolic function, with a mean left ventricular ejection fraction of 65.6±5.0%. The mean GLS was −17.92±4.80%. Radiographic sacroiliitis grade demonstrated a significant positive correlation with global longitudinal strain (r = 0.345, P = 0.046), apical two-chamber longitudinal strain (r = 0.455, P = 0.008), and apical four-chamber longitudinal strain (r = 0.392, P = 0.022), whereas no significant association was observed with apical three-chamber strain, aortic root diameter, or valvular abnormalities. Disease duration showed a moderate negative correlation with GLS (r = −0.544, P = 0.001), indicating greater impairment of myocardial deformation in patients with longer-standing disease.

Conclusions: Patients with AS demonstrated evidence of subclinical left ventricular myocardial dysfunction despite preserved conventional systolic function. Greater radiographic disease severity and longer disease duration were significantly associated with impaired myocardial deformation assessed by speckle-tracking echocardiography. These findings support the potential role of GLS as a sensitive imaging biomarker for the early detection of cardiac involvement in AS and highlight the importance of cardiovascular surveillance in patients with advanced or longstanding disease.

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Cite

BibTeXRIS
BibTeX
@article{reihan2026left,
  title = {{Left Ventricular Myocardial Deformation Abnormalities in Ankylosing Spondylitis (Radiographic Axial Spondyloarthritis): Association With Disease Severity Assessed by Two-Dimensional Speckle-Tracking Echocardiography}},
  author = {Muhammad Saad Reihan and Mohammed Moanes Mohammed Mohyeldin and Ahmed Al-Habbaa and Mohamed Sayed Bashandy and Husna Irfan Thalib and Ibrahim Fawzy Ezz and Mohamed Al-Adl Ali Ali and Abdelwahab Nasrat Bayoumy and Mohamad Abdel-Moez Ali},
  journal = {Cardiology research},
  year = {2026},
  month = oct,
  doi = {10.14740/cr2308},
  url = {https://europepmc.org/article/PMC/PMC13719652},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Left Ventricular Myocardial Deformation Abnormalities in Ankylosing Spondylitis (Radiographic Axial Spondyloarthritis): Association With Disease Severity Assessed by Two-Dimensional Speckle-Tracking Echocardiography
AU  - Muhammad Saad Reihan
AU  - Mohammed Moanes Mohammed Mohyeldin
AU  - Ahmed Al-Habbaa
AU  - Mohamed Sayed Bashandy
AU  - Husna Irfan Thalib
AU  - Ibrahim Fawzy Ezz
AU  - Mohamed Al-Adl Ali Ali
AU  - Abdelwahab Nasrat Bayoumy
AU  - Mohamad Abdel-Moez Ali
PY  - 2026
DA  - 2026/10/12
JO  - Cardiology research
DO  - 10.14740/cr2308
UR  - https://europepmc.org/article/PMC/PMC13719652
AB  - Background: Ankylosing spondylitis (AS), also termed radiographic axial spondyloarthritis (r-axSpA) under current Assessment of SpondyloArthritis international Society (ASAS) nomenclature, is a chronic inflammatory disorder associated with an increased risk of cardiovascular involvement, including subclinical myocardial dysfunction. Conventional echocardiography often fails to detect early myocardial abnormalities despite preserved left ventricular systolic function. Two-dimensional speckle-tracking echocardiography (2D-STE) enables sensitive assessment of myocardial deformation through global longitudinal strain (GLS), facilitating the early detection of subclinical cardiac involvement. This study aimed to evaluate left ventricular myocardial deformation in patients with AS using 2D-STE and investigate its relationship with disease severity and duration.  Methods: This cross-sectional observational study included 35 patients with AS diagnosed according to the Modified New York criteria. All participants underwent comprehensive clinical evaluation, laboratory investigations, conventional transthoracic echocardiography, and 2D-STE. Disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS). Radiographic disease severity was determined using the modified New York sacroiliitis grading system. Correlations between myocardial deformation parameters, radiographic severity, and disease duration were analyzed using Pearson’s correlation coefficient.  Results: The study population had a mean age of 33.9 ± 7.3 years, and 68.6% were male. Conventional echocardiography demonstrated preserved left ventricular systolic function, with a mean left ventricular ejection fraction of 65.6±5.0%. The mean GLS was −17.92±4.80%. Radiographic sacroiliitis grade demonstrated a significant positive correlation with global longitudinal strain (r = 0.345, P = 0.046), apical two-chamber longitudinal strain (r = 0.455, P = 0.008), and apical four-chamber longitudinal strain (r = 0.392, P = 0.022), whereas no significant association was observed with apical three-chamber strain, aortic root diameter, or valvular abnormalities. Disease duration showed a moderate negative correlation with GLS (r = −0.544, P = 0.001), indicating greater impairment of myocardial deformation in patients with longer-standing disease.  Conclusions: Patients with AS demonstrated evidence of subclinical left ventricular myocardial dysfunction despite preserved conventional systolic function. Greater radiographic disease severity and longer disease duration were significantly associated with impaired myocardial deformation assessed by speckle-tracking echocardiography. These findings support the potential role of GLS as a sensitive imaging biomarker for the early detection of cardiac involvement in AS and highlight the importance of cardiovascular surveillance in patients with advanced or longstanding disease.
SN  - 1923-2829
SN  - 1923-2837
ER  -