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
Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Rm 1929B, Block K, Hong Kong SAR, China.
Department of Ultrasound, Shenzhen Hospital of Southern Medical University, Shen Zhen, China.
Clin Rheumatol. 2020 Nov;39(11):3373-3382. doi: 10.1007/s10067-020-05112-5. Epub 2020 May 13.
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.
目的：轴性脊柱关节炎（SpA）患者面临更高的心血管疾病风险，但早期心肌损伤评估和临床风险分层仍不明确。本研究旨在评估斑点追踪应变分析和血清高敏肌钙蛋白I（hsTnI）在轴性SpA患者中的预后价值。 方法：采用二维斑点追踪超声心动图测量纵向应变（LS）、圆周应变（CS）和径向应变（RS）。采用经过验证的免疫测定法（雅培Architect i1000SR）检测血清hsTnI，作为亚临床心肌损伤的指标。 结果：平均巴斯强直性脊柱炎疾病活动指数和改良斯托克强直性脊柱炎脊柱评分中位数（mSASSS）分别为3.8和15.5。在中位随访81个月期间，13%的受试者（n = 116）发生了主要不良心血管事件（MACE）。单因素Cox回归分析显示，年龄、病程、巴斯强直性脊柱炎功能指数、改良Schober试验、mSASSS、hsTnI、室间隔厚度、E/E'、LS、RS和颈动脉内膜中层厚度是MACE的显著预测因素（均P < 0.05）。在对年龄、性别和具有统计学意义的疾病相关参数进行调整后，只有亚临床升高的hsTnI和受损的LS仍然是MACE的独立预测因素。Kaplan-Meier分析显示，LS受损≥−17.5%且hsTnI≥3.0 pg/ml的联合情况显著预测了MACE（对数秩检验P < 0.01；敏感性50%；特异性90%；阳性预测值43%；阴性预测值92%）。 结论：提示亚临床左心室收缩功能障碍的LS降低和血清hsTnI升高均独立预测了年轻轴性SpA患者的MACE。斑点追踪应变分析和血清hsTnI的联合分析改善了这些患者的风险分层。要点 • LS降低和血清高敏肌钙蛋白I（hsTnI）升高均是轴性SpA中心血管（CV）事件有前景的独立预测因素。 • 重要的是，LS≥−17.5%且hsTnI≥3.0 pg/ml的患者发生MACE的风险最高。 • 同时存在LS受损和hsTnI升高的轴性SpA患者发生CV事件的风险很高。
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