The Cardiac MRI Assessment of Myocardial Fibrosis in Ankylosing Spondylitis and Its Correlation with Transthoracic Echocardiography (TTE) and Clinical Activation Indices

Objectives: This study investigates cardiac involvement in ankylosing spondylitis (AS) using cardiac magnetic resonance imaging (MRI).The findings are correlated with transthoracic echocardiography (TTE) and clinical and laboratory data. Methods:The study included patients diagnosed with HLA-B27 positive AS for at least 10 years, without any known cardiac complications or risk factors, but with diastolic dysfunction detected via TTE.The average patient age was 40 years.Contrast-enhanced cardiac MRI was performed to assess cardiac morphology and myocardial pathologies.Disease activity was evaluated using the Bath Ankylosing Spondylitis Activity Index (BASDAI) and the Bath Ankylosing Spondylitis Functional Index (BASFI).Laboratory markers, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), were measured to determine disease activity. Results:Patients with increased clinical activation indices and prolonged E-wave deceleration time on tissue Doppler imaging exhibited myocardial pathology on cardiac MRI.MRI findings included intramural myocardial edema, late gadolinium enhancement, and myocardial thinning in the left ventricular wall.No statistically significant association was found between cardiac MRI findings and laboratory markers. Conclusion:AS patients with diastolic dysfunction may benefit from MRI to localize underlying myocardial pathology.Abnormal MRI findings were associated with higher disease activation indices, suggesting a role for inflammation in the pathogenesis of myocardial involvement in AS.