Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://cr.elmerpub.com

Original Article

Volume 000, Number 000, October 2026, pages 000-000

Left Ventricular Myocardial Deformation Abnormalities in Ankylosing Spondylitis (Radiographic Axial Spondyloarthritis): Association With Disease Severity Assessed by Two-Dimensional Speckle-Tracking Echocardiography

↓ Figure 1. Flow diagram of the patient selection process, showing the eligibility criteria and exclusion categories applied at Al-Husain Hospital (Cairo) and New Damietta Hospital (Damietta), Egypt, and the derivation of the final study population (N = 35).

↓ **Table 1.** Demographic and Clinical Characteristics of the Study Population (N = 35)
Variable	Value
AS: ankylosing spondylitis; ASDAS: Ankylosing Spondylitis Disease Activity Score; BASDAI: Bath Ankylosing Spondylitis Disease Activity Index; BMI: body mass index; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; HLA-B27: human leukocyte antigen B27; SD: standard deviation.
Age (years), mean ± SD	33.9 ± 7.3
Male sex, n (%)	24 (68.6)
Female sex, n (%)	11 (31.4)
Weight (kg), mean ± SD	79.2 ± 13.9
Height (cm), mean ± SD	168.0 ± 29.6
BMI (kg/m²), mean ± SD	26.7 ± 4.5
Disease duration (years), mean ± SD	12.2 ± 6.1
Duration of treatment (years), mean ± SD	3.1 ± 1.1
ESR (mm/h), mean ± SD	45.2 ± 23.4
CRP (mg/L), mean ± SD	16.4 ± 11.9
HLA-B27 positive, n (%)	23 (65.7)
ASDAS-CRP, mean ± SD	4.07 ± 5.70
ASDAS-ESR, mean ± SD	3.41 ± 0.65
BASDAI, mean ± SD	5.50 ± 1.23
Current smokers, n (%)	8 (22.9)
Hypertension, n (%)	2 (5.7)
History of fracture, n (%)	6 (17.1)
Positive family history of AS, n (%)	17 (48.6)
Peripheral arthritis, n (%)	30 (85.7)
Spinal pain, n (%)	33 (94.3)
Enthesitis, n (%)	29 (82.9)
Chest pain, n (%)	27 (77.1)
Uveitis, n (%)	3 (8.6)

↓ Table 1. Demographic and Clinical Characteristics of the Study Population (N = 35)

Variable

Value

AS: ankylosing spondylitis; ASDAS: Ankylosing Spondylitis Disease Activity Score; BASDAI: Bath Ankylosing Spondylitis Disease Activity Index; BMI: body mass index; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; HLA-B27: human leukocyte antigen B27; SD: standard deviation.

Age (years), mean ± SD

33.9 ± 7.3

Male sex, n (%)

24 (68.6)

Female sex, n (%)

11 (31.4)

Weight (kg), mean ± SD

79.2 ± 13.9

Height (cm), mean ± SD

168.0 ± 29.6

BMI (kg/m²), mean ± SD

26.7 ± 4.5

Disease duration (years), mean ± SD

12.2 ± 6.1

Duration of treatment (years), mean ± SD

3.1 ± 1.1

ESR (mm/h), mean ± SD

45.2 ± 23.4

CRP (mg/L), mean ± SD

16.4 ± 11.9

HLA-B27 positive, n (%)

23 (65.7)

ASDAS-CRP, mean ± SD

4.07 ± 5.70

ASDAS-ESR, mean ± SD

3.41 ± 0.65

BASDAI, mean ± SD

5.50 ± 1.23

Current smokers, n (%)

8 (22.9)

Hypertension, n (%)

2 (5.7)

History of fracture, n (%)

6 (17.1)

Positive family history of AS, n (%)

17 (48.6)

Peripheral arthritis, n (%)

30 (85.7)

Spinal pain, n (%)

33 (94.3)

Enthesitis, n (%)

29 (82.9)

Chest pain, n (%)

27 (77.1)

Uveitis, n (%)

3 (8.6)

↓ **Table 2.** Radiographic Severity and Valvular Abnormalities
Sacroiliitis grade	n (%)
AR: aortic regurgitation; MR: mitral regurgitation.
Grade II	17 (48.6)
Grade III	14 (40.0)
Grade IV	4 (11.4)
Valvular abnormalities	n (%)
No valvular abnormality	25 (71.4)
Mild MR	2 (5.7)
Mild AR	1 (2.9)
Calcified mitral and aortic valves	4 (11.4)
Calcific aortic valve with mild AR	1 (2.9)
Calcified mitral valve with mild MR and calcified aortic valve	2 (5.7)

↓ Table 2. Radiographic Severity and Valvular Abnormalities

Sacroiliitis grade

n (%)

AR: aortic regurgitation; MR: mitral regurgitation.

Grade II

17 (48.6)

Grade III

14 (40.0)

Grade IV

4 (11.4)

Valvular abnormalities

n (%)

No valvular abnormality

25 (71.4)

Mild MR

2 (5.7)

Mild AR

1 (2.9)

Calcified mitral and aortic valves

4 (11.4)

Calcific aortic valve with mild AR

1 (2.9)

Calcified mitral valve with mild MR and calcified aortic valve

2 (5.7)

↓ **Table 3.** Conventional Echocardiographic Parameters
Variable	Mean ± SD
^aAvailable for 20 patients. ^bAvailable for 33 patients. ^cAvailable for 28 patients. IVS: interventricular septum; LVEDD: left ventricular end-diastolic diameter; LVPW: left ventricular posterior wall; LVESD: left ventricular end-systolic diameter; LVEF: left ventricular ejection fraction; LVFS: left ventricular fractional shortening; SD: standard deviation.
Aortic root diameter (mm)	30.9 ± 3.8
Left atrial diameter (mm)	33.8 ± 5.5
Right ventricular diameter (mm)	21.6 ± 4.3
IVS thickness (mm)	8.2 ± 1.2
LVEDD (mm)	49.3 ± 3.3
LVPW thickness (mm)	8.0 ± 1.2
LVESD (mm)	31.8 ± 2.8
LVEF (%)	65.6 ± 5.0
LVFS (%)^a	35.5 ± 4.1
Mitral E velocity (cm/s)^b	74.7 ± 16.5
Mitral A velocity (cm/s)^b	57.2 ± 14.2
E/A ratio‡	1.32 ± 0.28
Left atrial volume index (mL/m²)^a	25.4 ± 10.5
Septal e′ velocity (cm/s)^c	10.7 ± 2.9

↓ Table 3. Conventional Echocardiographic Parameters

Variable

Mean ± SD

^aAvailable for 20 patients. ^bAvailable for 33 patients. ^cAvailable for 28 patients. IVS: interventricular septum; LVEDD: left ventricular end-diastolic diameter; LVPW: left ventricular posterior wall; LVESD: left ventricular end-systolic diameter; LVEF: left ventricular ejection fraction; LVFS: left ventricular fractional shortening; SD: standard deviation.

Aortic root diameter (mm)

30.9 ± 3.8

Left atrial diameter (mm)

33.8 ± 5.5

Right ventricular diameter (mm)

21.6 ± 4.3

IVS thickness (mm)

8.2 ± 1.2

LVEDD (mm)

49.3 ± 3.3

LVPW thickness (mm)

8.0 ± 1.2

LVESD (mm)

31.8 ± 2.8

LVEF (%)

65.6 ± 5.0

LVFS (%)^a

35.5 ± 4.1

Mitral E velocity (cm/s)^b

74.7 ± 16.5

Mitral A velocity (cm/s)^b

57.2 ± 14.2

E/A ratio‡

1.32 ± 0.28

Left atrial volume index (mL/m²)^a

25.4 ± 10.5

Septal e′ velocity (cm/s)^c

10.7 ± 2.9

↓ **Table 4.** Left Ventricular Myocardial Deformation Parameters
Parameter	Mean ± SD
^aAvailable for 19 patients. SD: standard deviation.
E/e′ ratio^a	7.42 ± 2.48
Apical four-chamber longitudinal strain (%)	−18.58 ± 4.89
Apical two-chamber longitudinal strain (%)	−17.83 ± 6.23
Apical three-chamber longitudinal strain (%)	−16.66 ± 4.91
Global longitudinal strain (GLS) (%)	−17.92 ± 4.80

↓ Table 4. Left Ventricular Myocardial Deformation Parameters

Parameter

Mean ± SD

^aAvailable for 19 patients. SD: standard deviation.

E/e′ ratio^a

7.42 ± 2.48

Apical four-chamber longitudinal strain (%)

−18.58 ± 4.89

Apical two-chamber longitudinal strain (%)

−17.83 ± 6.23

Apical three-chamber longitudinal strain (%)

−16.66 ± 4.91

Global longitudinal strain (GLS) (%)

−17.92 ± 4.80

↓ **Table 5.** Correlation Between Disease Severity and Echocardiographic Parameters
Variable	Correlation coefficient (r)	P value
*Statistical significance (P < 0.05).
Sacroiliitis grade vs. valvular abnormalities	−0.188	0.280
Sacroiliitis grade vs. aortic root diameter	0.266	0.123
Sacroiliitis grade vs. global longitudinal strain	0.345	0.046*
Sacroiliitis grade vs. apical three-chamber LS	0.196	0.268
Sacroiliitis grade vs. apical two-chamber LS	0.455	0.008*
Sacroiliitis grade vs. apical four-chamber LS	0.392	0.022*
Disease duration vs. global longitudinal strain	−0.544	0.001*

↓ Table 5. Correlation Between Disease Severity and Echocardiographic Parameters

Variable

Correlation coefficient (r)

P value

*Statistical significance (P < 0.05).

Sacroiliitis grade vs. valvular abnormalities

−0.188

0.280

Sacroiliitis grade vs. aortic root diameter

0.266

0.123

Sacroiliitis grade vs. global longitudinal strain

0.345

0.046*

Sacroiliitis grade vs. apical three-chamber LS

0.196

0.268

Sacroiliitis grade vs. apical two-chamber LS

0.455

0.008*

Sacroiliitis grade vs. apical four-chamber LS

0.392

0.022*

Disease duration vs. global longitudinal strain

−0.544

0.001*