Cardiovascular events prediction by left ventricular longitudinal strain and serum high-sensitivity troponin I in patients with axial spondyloarthritis

• Published in: Clinical rheumatology Vol. 39; no. 11; pp. 3373 - 3382
• Main Authors: Chen, Yan, Chan, Yap-Hang, Chung, Ho-Yin, Wu, Mei-Zhen, Yu, Yu-Juan, Pi, Kang-Li, Lau, Chak-Sing, Tse, Hung-Fat, Yiu, Kai-Hang
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.11.2020; Springer Nature B.V
• Subjects: Ankylosing spondylitis; Arthritis; Calcium-binding protein; Carotid Intima-Media Thickness; Echocardiography; Heart; Heart Ventricles; Humans; Inflammatory diseases; Medicine; Medicine & Public Health; Original Article; Patients; Rheumatic diseases; Rheumatology; Risk assessment; Sensitivity analysis; Spondylarthritis; Statistical analysis; Troponin; Troponin I; Ventricle; Ventricular Dysfunction, Left; Ventricular Function, Left; High-sensitivity troponin I; Axial spondyloarthritis; Left ventricular longitudinal strain; Major adverse cardiovascular events
• ISSN: 0770-3198; 1434-9949
• DOI: 10.1007/s10067-020-05112-5

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.