The Role of the Three‐Dimensional Systolic Dyssynchrony Index and Autonomic Dysfunction Parameters in Detecting Subclinical Cardiac Involvement in Ankylosing Spondylitis
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Wiley
2026
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| author | Kutluhan Eren Hazir Öner Özdoğan Ali Kemal Çabuk Zevcet Yilmaz |
| author_facet | Kutluhan Eren Hazir Öner Özdoğan Ali Kemal Çabuk Zevcet Yilmaz Kutluhan Eren Hazir Öner Özdoğan Ali Kemal Çabuk Zevcet Yilmaz |
| collection | Wiley Open Access |
| contents | The Role of the Three‐Dimensional Systolic Dyssynchrony Index and Autonomic Dysfunction Parameters in Detecting Subclinical Cardiac Involvement in Ankylosing Spondylitis Kutluhan Eren Hazir Öner Özdoğan Ali Kemal Çabuk Zevcet Yilmaz Echocardiography 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. 10.1111/echo.70430 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| doi_str_mv | 10.1111/echo.70430 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_echo_70430 |
| institution | Wiley Open Access |
| license_str_mv | http://onlinelibrary.wiley.com/termsAndConditions#vor |
| publishDate | 2026 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | The Role of the Three‐Dimensional Systolic Dyssynchrony Index and Autonomic Dysfunction Parameters in Detecting Subclinical Cardiac Involvement in Ankylosing Spondylitis Kutluhan Eren Hazir Öner Özdoğan Ali Kemal Çabuk Zevcet Yilmaz Echocardiography The Role of the Three‐Dimensional Systolic Dyssynchrony Index and Autonomic Dysfunction Parameters in Detecting Subclinical Cardiac Involvement in Ankylosing Spondylitis Kutluhan Eren Hazir Öner Özdoğan Ali Kemal Çabuk Zevcet Yilmaz Echocardiography 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. 10.1111/echo.70430 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| title | The Role of the Three‐Dimensional Systolic Dyssynchrony Index and Autonomic Dysfunction Parameters in Detecting Subclinical Cardiac Involvement in Ankylosing Spondylitis |
| topic | Echocardiography |
| url | https://onlinelibrary.wiley.com/doi/10.1111/echo.70430 |