title: Left ventricular myocardial dysfunction and premature atherosclerosis in patients with axial spondyloarthritis.
abstract: OBJECTIVE
  To evaluate left ventricular (LV) function and carotid intima-media thickness (IMT) in patients with axial SpA in relationship to underlying disease severity.
  
  
  METHODS
  We recruited 104 patients with axial SpA and 50 controls. Detailed transthoracic echocardiography was performed and analysed with two-dimensional speckle tracking strain analysis for systolic function and tissue Doppler-derived E/E' for diastolic function assessment. Carotid IMT was measured by ultrasonography to evaluate subclinical atherosclerosis. Radiological severity of patients with axial SpA was assessed by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS).
  
  
  RESULTS
  Despite a similar LV ejection fraction [62.7% (s.d. 3.9) vs 62.8% (s.d. 3.8), P = 0.83], patients with axial SpA had impaired LV myocardial longitudinal strain (LS), circumferential strain (CS) and radial strain (RS) compared with controls [-18.1% (s.d. 2.4) vs -20.1% (s.d. 2.5), -17.2% (s.d. 2.2) vs -20.3% (s.d. 2.9) and 37.1% (s.d. 8.6) vs 43.2% (s.d. 10.9), respectively; all P < 0.01]. In addition, patients with axial SpA had a greater E/E' [7.9 (s.d. 2.5) vs 7.0 (s.d. 1.7), P < 0.01] and carotid IMT [0.78 mm (s.d. 0.19) vs 0.69 mm (s.d. 0.10), P < 0.01] than controls. After adjusting for potential confounding factors, axial SpA remained independently associated with LV myocardial strains, E/E' and carotid IMT. Importantly, multivariate linear regression analysis demonstrated that mSASSS was independently associated with LV longitudinal strain, E/E' and carotid IMT.
  
  
  CONCLUSIONS
  Our study demonstrated that patients with axial SpA had impaired LV systolic and diastolic function and increased carotid IMT. Importantly, mSASSS was independently associated with LV longitudinal strain, E/E' and carotid IMT after adjusting for confounding factors. Speckle tracking echocardiography may be a useful tool for early detection of impaired LV function in patients with SpA and carotid IMT examination can provide valuable assessment of subclinical atherosclerosis in patients with SpA.
authors.affiliation: Cardiology Division, Division of Rheumatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region (SAR), Cardiology Division, Department of Medicine, University of Hong Kong Shenzhen Hospital, Shenzhen and Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Cardiology Division, Division of Rheumatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region (SAR), Cardiology Division, Department of Medicine, University of Hong Kong Shenzhen Hospital, Shenzhen and Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China.
authors.forename: Ho-Yin
authors.initials: HY
authors.lastname: Chung
authors.affiliation: Cardiology Division, Division of Rheumatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region (SAR), Cardiology Division, Department of Medicine, University of Hong Kong Shenzhen Hospital, Shenzhen and Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China.
authors.forename: Chun-Ting
authors.initials: CT
authors.lastname: Zhao
authors.affiliation: Cardiology Division, Division of Rheumatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region (SAR), Cardiology Division, Department of Medicine, University of Hong Kong Shenzhen Hospital, Shenzhen and Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China.
authors.forename: Arthur
authors.initials: A
authors.lastname: Wong
authors.affiliation: Cardiology Division, Division of Rheumatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region (SAR), Cardiology Division, Department of Medicine, University of Hong Kong Shenzhen Hospital, Shenzhen and Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Zhen
authors.affiliation: Cardiology Division, Division of Rheumatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region (SAR), Cardiology Division, Department of Medicine, University of Hong Kong Shenzhen Hospital, Shenzhen and Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China.
authors.forename: Helen Hoi-Lun
authors.initials: HH
authors.lastname: Tsang
authors.affiliation: Cardiology Division, Division of Rheumatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region (SAR), Cardiology Division, Department of Medicine, University of Hong Kong Shenzhen Hospital, Shenzhen and Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China.
authors.forename: Chak-Sing
authors.initials: CS
authors.lastname: Lau
authors.affiliation: Cardiology Division, Division of Rheumatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region (SAR), Cardiology Division, Department of Medicine, University of Hong Kong Shenzhen Hospital, Shenzhen and Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China. Cardiology Division, Division of Rheumatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region (SAR), Cardiology Division, Department of Medicine, University of Hong Kong Shenzhen Hospital, Shenzhen and Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China. Cardiology Division, Division of Rheumatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region (SAR), Cardiology Division, Department of Medicine, University of Hong Kong Shenzhen Hospital, Shenzhen and Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China.
authors.forename: Hung-Fat
authors.initials: HF
authors.lastname: Tse
authors.affiliation: Cardiology Division, Division of Rheumatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region (SAR), Cardiology Division, Department of Medicine, University of Hong Kong Shenzhen Hospital, Shenzhen and Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China. Cardiology Division, Division of Rheumatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region (SAR), Cardiology Division, Department of Medicine, University of Hong Kong Shenzhen Hospital, Shenzhen and Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China. Cardiology Division, Division of Rheumatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region (SAR), Cardiology Division, Department of Medicine, University of Hong Kong Shenzhen Hospital, Shenzhen and Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China. khkyiu@hku.hk hftse@hkucc.hku.hk.
authors.forename: Kai-Hang
authors.initials: KH
authors.lastname: Yiu
mesh_terms: D000328:Adult; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000209:etiology*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D004452:Echocardiography / Q000379:methods; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013167:Spondylitis, Ankylosing / Q000150:complications*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology*
keywords: axial spondyloarthritis; carotid intima-media thickness; left ventricular function