The effects of golimumab treatment on systolic and diastolic left ventricular function in ankylosing spondylitis

Figures & data

Figure 1 Flowchart of included patients.

Table 1 Baseline characteristics

Variables
Age, years (mean ± SD)	41.8±10.8
Gender, male n (%)	27 (68)
Body mass index, kg/m^2 (median, range)	24.4 (21.9–28.0)
Hypertension n (%)	6 (15)
Diabetes mellitus type 2 n (%)	1 (3)
Disease characteristics
Years since disease onset (median, range)	16 (9–24)
Years since diagnosis (median, range)	8 (2–16)
HLA-B27 positive n (%)	33 (83)
Systolic blood pressure, mmHg (mean ± SD)	126±13
Diastolic blood pressure, mmHg (mean ± SD)	81±7
ESR, mm/h (median, range)	10 (6–22)
CRP, mg/L (median, range)	4 (1–12)
BASDAI (mean ± SD)	5.6±1.7
BASFI (mean ± SD)	4.5±2.4
ASDAS (mean ± SD)	3.2±1.2
Prior anti TNF-α medication use n (%)	22 (55)
Current NSAIDs use n (%)	33 (83)
Years of prior anti TNF-α medication use (median, range)	0.3 (0.0–4.0)
Echocardiography
Cardiac abnormality n (%)*	13 (33)
Systolic LV dysfunction n (%)	0 (0)
Diastolic LV dysfunction n (%)	9 (23)
Grade I/II/III n (%)	7 (18)/2 (5)/0 (0)
Aortic valve dysfunction n (%)	1 (3)
Aortic dilatation n (%)	2 (5)
Structural abnormality n (%)	2 (5)
LV mass index, g/m^2 (mean ± SD)	74.7±16.6
LA volume/BSA, mL/m^2 (mean ± SD)	24.3±6.9
Aortic root diameter, mm (mean ± SD)	3.1±0.4
Mitral dysfunction n (%)	8 (20)
Ejection fraction, % (mean ± SD)	60.0±4.8
Peak E velocity, cm/s (mean ± SD)	79.7±15.6
Peak A velocity, cm/s (mean ± SD)	60.3±13.4
E/A ratio (mean ± SD)	1.38±0.4
Deceleration time, ms (mean ± SD)	191±33
e’ septal, cm/s (mean ± SD)	9.9±2.4
E/e’ ratio (mean ± SD)	7.5±1.7

Notes:

* Statistically significant: P<0.05.

Abbreviations: ASDAS, Ankylosing Spondylitis Disease Activity Score; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; BASFI, Bath Ankylosing Spondylitis Functional Index; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; LV, left ventricular; NSAID, non-steroidal anti-inflammatory drug; TNF-α, tumor necrosis factor alpha.

Table 2 Echocardiographic data

Cardiac abnormalities	AS patients
Cardiac abnormality n (%)*	13 (33)
Systolic LV dysfunction n (%)	0 (0)
Diastolic LV dysfunction n (%)	9 (23)
Grade I/II/III n (%)	7 (18)/2 (5)/0 (0)
Aortic valve dysfunction n (%)	1 (3)
Aortic dilatation n (%)	2 (5)
Structural abnormality n (%)	2 (5)
Other echocardiography variables
LV mass index, g/m^2 (mean ± SD)	74.7±16.6
LA volume / BSA, mL/m^2 (mean ± SD)	24.3±6.9
Aortic root diameter, mm (mean ± SD)	3.1±0.4
Mitral dysfunction n (%)	8 (20)
Ejection fraction, % (mean ± SD)	60.0±4.8
Diastolic LV function variables
Peak E velocity, cm/s (mean ± SD)	79.7±15.6
Peak A velocity, cm/s (mean ± SD)	60.3±13.4
E/A ratio (mean ± SD)	1.38±0.4
Deceleration time, ms (mean ± SD)	191±33
e’ septal, cm/s (mean ± SD)	9.9±2.4
E/e’ ratio (mean ± SD)	7.5±1.7

Notes:

* Statistically significant: P<0.05, One AS patient and one control ad two abnormalities.

Abbreviations: AS, ankylosing spondylitis; BSA, body surface area; LA, left atrium; LV, left ventricular; n, number.

Table 3 Differences in characteristics of study population between AS patients with and without diastolic LV dysfunction at baseline

Variables	Normal diastolic LV function (n=31)	Diastolic LV dysfunction (n=9)	P-value
Age, years (mean ± SD)	38.7±9.8	52.2±7.2	<0.001*
Years since diagnosis (median, range)	8.0 (2.0–13.0)	8.0 (2.0–19.0)	0.649
HLA-B27 positive n (%)	26 (84)	7 (78)	0.645
CRP, mg/L (median, range)	4 (1–12)	9 (6–20)	0.132
ESR, mm/h (median, range)	6 (5–25)	14 (6–46)	0.292
SBP, mmHg (mean ± SD)	124±13	130±10	0.190
DBP, mmHg (mean ± SD)	80±7	83±2	0.256
Hypertension n (%)	2 (6)	4 (44)	0.002*
Prior anti TNF-α medication use n (%)	18 (58)	4 (44)	0.705
NSAIDs usage n (%)	25 (81)	8 (88)	1.000
BASDAI (mean ± SD)	5.7±1.8	5.1±1.6	0.761
ASDAS (mean ± SD)	3.2±1.2	3.3±1.0	0.405

Note:

* Statistically significant: P<0.05.

Abbreviations: ASDAS, Ankylosing Spondylitis Disease Activity Score; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; CRP, C-reactive protein; DBP, diastolic blood pressure; ESR, erythrocyte sedimentation rate; LV, left ventricular; NSAID, non-steroidal anti-inflammatory drug; SBP, systolic blood pressure; TNF, tumor necrosis factor.

Table 4 Effects of TNF-α blocking therapy

Disease variables	Baseline	One year	P-value
CRP, mg/L (median, range)	5.0 (2.0–12.0)	2.0 (1.9–3.2)	<0.001
ESR, mm/h (median, range)	10.0 (6.0–22.0)	4.0 (2.0–7.0)	<0.001
BASDAI (mean ± SD)	5.2±1.6	3.7±2.3	0.001
ASDAS (mean ± SD)	3.1±1.2	2.0±1.0	<0.001
SBP, mmHg (mean ± SD)	127±13	124±11	0.095
DBP, mmHg (mean ± SD)	82±7	83±8	0.472
Echocardiographic variables
LV mass index, g/m^2 (mean ± SD)	75.1±17.7	73.1±15.0	0.389
LA volume / BSA, mL/m^2 (mean ± SD)	24.4±6.8	25.8±7.8	0.384
Ejection fraction, % (mean ± SD)	60.4±4.5	58.8±4.7	0.081
LVEDVI (mean ± SD)	65.1±13.4	64.1±12.1	0.313
LVESVI (mean ± SD)	26.2±7.2	27.1±6.3	0.966
Systolic LV dysfunction n (%)	0 (0)	0 (0)	N/A
Diastolic LV dysfunction n (%)	6 (20)	2 (6)	0.125
Grade I/II/III n (%)	4 (13) / 2 (5) / 0 (0)	1 (3) / 1 (3) / 0 (0)
E/A ratio (mean ± SD)	1.42±0.37	1.42±0.46	0.923
Deceleration time, ms (mean ± SD)	192±32	198±28	0.415
E/e’ ratio (mean ± SD)	7.7±1.8	7.2±1.2	0.104

Abbreviations: AS, ankylosing spondylitis; ASDAS, Ankylosing Spondylitis Disease Activity Score; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; BSA, body surface area; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; LA, left atrial; LV, left ventricular; LVEDVI, left ventricular end-diastolic volume index; LVESVI, left ventricular end-systolic volume index; N/A, not applicable; n, number; TNF-α, tumor necrosis factor alpha.

Figure 2 The effect of golimumab treatment on diastolic left ventricular function.