What question did this study set out to answer?

This study investigates subclinical cardiac dysfunction in ankylosing spondylitis (AS) patients, focusing on mechanical dyssynchrony and autonomic dysfunction.

April 1, 2026

The Role of the Three‐Dimensional Systolic Dyssynchrony Index and Autonomic Dysfunction Parameters in Detecting Subclinical Cardiac Involvement in Ankylosing Spondylitis

Key Points

This study investigates subclinical cardiac dysfunction in ankylosing spondylitis (AS) patients, focusing on mechanical dyssynchrony and autonomic dysfunction.
Conducted a cross-sectional study with 50 AS patients and 31 healthy controls.
Used two-dimensional and three-dimensional echocardiography to assess left ventricular function and dyssynchrony index.
Performed 24-hour Holter monitoring to evaluate heart rate variability and clinical assessment using Bath AS Disease Activity Index.
AS patients showed significantly higher 16-SDI values compared to controls (3.48% vs. 1.64%, p < 0.001).
HRV indices were lower in AS patients, indicating autonomic dysfunction (p < 0.01 for all).
BASDAI correlated positively with 16-SDI (r = 0.650, p < 0.001), predicting increased dyssynchrony in multivariable analysis.

Abstract

ABSTRACT 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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