Yan Chen1,2, Yap-Hang Chan1, Ho-Yin Chung3, Mei-Zhen Wu1, Yu-Juan Yu1, Kang-Li Pi1, Chak-Sing Lau3, Hung-Fat Tse1,4, Kai-Hang Yiu5,6. 1. Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Rm 1929B, Block K, Hong Kong SAR, China. 2. Department of Ultrasound, Shenzhen Hospital of Southern Medical University, Shen Zhen, China. 3. Division of Rheumatology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China. 4. Cardiology Division, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Shen Zhen, China. 5. Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Rm 1929B, Block K, Hong Kong SAR, China. khkyiu@hku.hk. 6. Cardiology Division, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Shen Zhen, China. khkyiu@hku.hk.
Abstract
OBJECTIVE: Patients with axial spondyloarthritis (SpA) are subjected to elevated cardiovascular risks, but assessment of early myocardial damage and clinical risk stratification remained obscure. The aim of this study was to evaluate the prognostic value of speckle-tracking strain analysis and serum high-sensitivity troponin I (hsTnI) in patients with axial SpA. METHODS: Two-dimensional speckle-tracking echocardiography was performed to derive longitudinal strain (LS), circumferential strain (CS), and radial strain (RS). Serum hsTnI was measured by validated immunoassay (Architect i1000SR Abbott) as indicator of subclinical myocardial damage. RESULTS: The mean Bath Ankylosing Spondylitis Disease Activity Index and median modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) were 3.8 and 15.5, respectively. Over a median follow-up of 81 months, major adverse cardiovascular events (MACE) occurred in 13% of subjects (n = 116). Univariate Cox regression showed that age, disease duration, Bath Ankylosing Spondylitis Functional Index, modified Schober test, mSASSS, hsTnI, interventricular septal thickness, E/E', LS, RS, and carotid intima-media thickness were significant predictors of MACE (all P < 0.05). After adjustment for age, sex, and statistically significant disease-related parameters, only subclinically raised hsTnI and impaired LS remained independent predictors for MACE. Kaplan-Meier analysis showed that combined impaired LS ≥ - 17.5% and hsTnI ≥ 3.0 pg/ml significantly predicted MACE (log-rank test P < 0.01; sensitivity 50%; specificity 90%; positive predictive value 43%; negative predictive value 92%). CONCLUSIONS: Depressed LS indicating subclinical left ventricular systolic dysfunction and elevated serum hsTnI both independently predicted MACE among young patients with axial SpA. Combined analysis of speckle-tracking-derived strain analysis and serum hsTnI improves risk stratification in these patients. Key Points • Both depressed longitudinal strain (LS) and elevated serum high-sensitivity troponin I (hsTnI) are promising independent predictors for cardiovascular (CV) events in axial SpA. • Importantly, patients with LS ≥ - 17.5% and hsTnI ≥ 3.0 pg/ml had the highest risk of incident MACE. • Axial SpA patients with concomitant impaired LS and raised hsTnI are at a high risk of CV events.
OBJECTIVE: Patients with axial spondyloarthritis (SpA) are subjected to elevated cardiovascular risks, but assessment of early myocardial damage and clinical risk stratification remained obscure. The aim of this study was to evaluate the prognostic value of speckle-tracking strain analysis and serum high-sensitivity troponin I (hsTnI) in patients with axial SpA. METHODS: Two-dimensional speckle-tracking echocardiography was performed to derive longitudinal strain (LS), circumferential strain (CS), and radial strain (RS). Serum hsTnI was measured by validated immunoassay (Architect i1000SR Abbott) as indicator of subclinical myocardial damage. RESULTS: The mean Bath Ankylosing Spondylitis Disease Activity Index and median modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) were 3.8 and 15.5, respectively. Over a median follow-up of 81 months, major adverse cardiovascular events (MACE) occurred in 13% of subjects (n = 116). Univariate Cox regression showed that age, disease duration, Bath Ankylosing Spondylitis Functional Index, modified Schober test, mSASSS, hsTnI, interventricular septal thickness, E/E', LS, RS, and carotid intima-media thickness were significant predictors of MACE (all P < 0.05). After adjustment for age, sex, and statistically significant disease-related parameters, only subclinically raised hsTnI and impaired LS remained independent predictors for MACE. Kaplan-Meier analysis showed that combined impaired LS ≥ - 17.5% and hsTnI ≥ 3.0 pg/ml significantly predicted MACE (log-rank test P < 0.01; sensitivity 50%; specificity 90%; positive predictive value 43%; negative predictive value 92%). CONCLUSIONS: Depressed LS indicating subclinical left ventricular systolic dysfunction and elevated serum hsTnI both independently predicted MACE among young patients with axial SpA. Combined analysis of speckle-tracking-derived strain analysis and serum hsTnI improves risk stratification in these patients. Key Points • Both depressed longitudinal strain (LS) and elevated serum high-sensitivity troponin I (hsTnI) are promising independent predictors for cardiovascular (CV) events in axial SpA. • Importantly, patients with LS ≥ - 17.5% and hsTnI ≥ 3.0 pg/ml had the highest risk of incident MACE. • Axial SpA patients with concomitant impaired LS and raised hsTnI are at a high risk of CV events.
Entities:
Keywords:
Axial spondyloarthritis; High-sensitivity troponin I; Left ventricular longitudinal strain; Major adverse cardiovascular events
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