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Myocardial performance index to assess cardiac function in spondyloarthritis: A systematic review and meta-analysis Cover

Myocardial performance index to assess cardiac function in spondyloarthritis: A systematic review and meta-analysis

Romanian Journal of Internal Medicine
Volume 63 (2025): Issue 3 (September 2025)
By: Steven Alvianto,  Faisal Parlindungan,  Naomi Niari Dalimunthe,  Nicolas Daniel Widjanarko,  Yovita Gotama,  Ummi Kultsum and  Cristopher Efendi  
Open Access
|Jul 2025

Figures & Tables

Figure 1.

PRISMA 2020 Flow Diagram of Included Studies.
PRISMA 2020 Flow Diagram of Included Studies.

Figure 2.

Meta-Analysis Results [Forest Plot] for Myocardial Performance Index in Ankylosing Spondylitis (AS) compared to healthy control; A: Conventional Myocardial Performance Index (cMPI) B: Tissue Doppler Myocardial Performance Index (tdMPI).
Meta-Analysis Results [Forest Plot] for Myocardial Performance Index in Ankylosing Spondylitis (AS) compared to healthy control; A: Conventional Myocardial Performance Index (cMPI) B: Tissue Doppler Myocardial Performance Index (tdMPI).

Results of Quality Assessment using Newcastle-Ottawa Scale (NOS) adopted for cross-sectional studies_

NoFirst Author, Year of Publication, CountrySelectionComparabilityOutcomeOverall Risk of Bias
S1S2S3S4O1O2
1Albayrak et al., 2013, Turkey [27]0**********Good study
2Ozmen et al., 2020, Turkey [29]00********Good study

GRADE evidence profile_

OutcomeNumber of participants (studies)Quality AssessmentSummary findings
Newcastle Ottawa Scale (NOS)InconsistencyIndirectnessImprecisionPublication biasOverall quality of evidenceMD total95% CI (lower, upper)
Conventional MPI230 case 244 control (5 studies)Not SeriousSeriousaNot SeriousSeriousbNot SeriouscModerate0.05(0.01, 0.08)
Tissue Doppler MPI171 case 93 control (3 studies)Not SeriousNot SeriousNot SeriousSeriousbNot SeriouscModerate0.08(0.06, 0.10)

Results of Quality Assessment using Newcastle-Ottawa Scale (NOS) adopted for case-control studies_

NoFirst Author, Year of Publication, CountrySelectionComparabilityOutcomeOverall Risk of Bias
S1S2S3S4O1O2O3
1Kucuk et al., 2018, Turkey [28]**0******Good quality
2Nageeb G et al., 2013, Egypt [32]**0****0Good quality
3Kocabas H et al, 2018, Turkey [25]*00*****Fair quality
4Rosa RE et al, 2015, Brazil [10]******0**Good quality
5Seddik et al., 2023, Egypt [21]**0****0Good quality
6Moyssakis et al., 2009, Greece [26]**0*****0Good quality
7Okan T et al., 2008, Turkey [30]**0*****0Good quality
8Acar G et al., 2009, Turkey [20]**0******Good quality
9Kiris A et al., 2012 [31]********0Good quality

PICOTS-SD

PatientsAdult patients with Spondyloarthritis
InterventionEchocardiography
ComparatorHealthy adults patients
OutcomesMyocardial Performance Index
TimePublished year of 1995 (Myocardial Performance Index first introduced) - 2023
SettingParticipants visiting medical facility
Study DesignObservational study design

Results of Conventional Myocardial Performance Index (cMPI) in Spondyloarthritis (SpA) compared to healthy control_

NoAuthor, YearConventional Myocardial Performance Index (cMPI)
SpAControlp-value
MeanSDParticipantsMeanSDParticipants
Undifferentiated Spondyloarthritis (uSpA)
1Albayrak 2013 [27]0.490.05400.490.08401.0
Ankylosing Spondylitis (AS)
1Okan 2008 [30]0.490.06490.410.04330.0001
2Moyssakis 2009 [26]0.3920.031570.370.034780.0002
3Kocabas 2018 [25]0.710.15350.570.18380.0006
4Kucuk 2018 [28]0.540.1300.530.1300.70
5Ozmen 2020 [29]0.410.11590.380.08650.083

Results of Tissue Doppler Myocardial Performance Index (tdMPI) in Spondyloarthritis (SpA) compared to healthy control_

NoAuthor, YearTissue Doppler Myocardial Performance Index (tdMPI)
SpAControlp-value
MeanSDParticipantsMeanSDParticipants
Undifferentiated Spondyloarthritis (uSpA)
1Albayrak 2013 [27]0.450.1400.440.07400.1078
Ankylosing Spondylitis (AS)
1Okan 2008 [30]0.470.07490.390.04330.0001
2Kiris 2012 [31]0.40.13770.330.1400.0036
3Nageeb 2013 [32]0.450.09450.360.07200.0002

Study Characteristics

NoAuthor, Publication YearCountryType of studyEchocardiography techniqueParticipantDisease Duration (years)Disease ActivityOutcome of Interest
NAge (years)
CaseControlCaseControl
uSpA
1Albayrak et al., 2013 [27]TurkeyCross-sectional studyTTE

  • 40

  • Male: 5 (12.5%)

  • Female: 35 (87.5%)

  • 40

  • Male: 6 (15%)

  • Female: 34 (85%)

43.4 ±9.141.1± 8.9N/AN/AConventional Echocardiography

  • LV Systolic indices:

    EF in uSpA (69.3±7.06%) and control (67.7±3.9%) were similar (p=0.202).

  • LV Diastolic indices:

    E/A ratios in the uSpA group (1.22±0.31) vs control (1.21±0.21) were similar (p=0.852).

Tissue Doppler Imaging

  • LV Diastolic indices:

    Em/Am ratio in the uSpA group (1.32±0.54) vs control (1.46±0.45) were similar (p=0.219)

AS
2Kucuk et al., 2018 [28]TurkeyCase-control studyTTE

  • 30

  • Male: 8 (27%)

  • Female: 22 (73%)

  • 30

  • Male: 11 (36%)

  • Female: 19 (63%)

41.0 ± 9.237.5 ± 10.78.53

  • BASDAI: 3.32 ± 2.5

  • BASFI: 2.86 ± 2.3,

  • BASMI: 3.12 ± 2.1

Conventional Echocardiography

  • LV Systolic indices:

    EF in AS (68.4±8.0%) and control (71.9±5.8%) were similar (p=0.417).

  • LV Diastolic indices:

    E/Em in AS (6.8±2.9) vs control (7.9±2.7) (p=0.782)

  • Other outcomes:

    MPI’s correlation coefficient with a number of AS group variables

    • BMI: r = 0.059, p = 0.121

    • ESR: r = 0.278, p = 0.013

    • CRP: r = 0.136, p = 0.233

    • Systolic Blood Pressure (SBP): r = 0.022, p = 0.846

    • Diastolic Blood Pressure (DBP): r = 0.169, p = 0.135

    • Left Atrium (LA): r = −0.099, p = 0.384

    • Ejection Fraction (EF): r = −0.078, p = 0.492

    • Red Cell Distribution Width (RDW): r = 0.372, p = 0.001

    • Neutrophil-to-Lymphocyte Ratio (NLR): r = 0.028, p = 0.805

    • Mean Platelet Volume (MPV): r = 0.002, p = 0.988

3Özmen C et al., 2020 [29]TurkeyCross-sectional studyTTE

  • 59

  • Male: 34 (58%)

  • Female: 25 (42%)

  • 65

  • Male: 42 (65%)

  • Female: 23 (35%)

44.0 (36.0–52.0)45.0 (29.5–56.5)At least 1-yearN/AConventional Echocardiography

  • LV Systolic indices:

    • EF in AS (62.9±2.9) vs control (64.7±2.5) were significantly different (p=0.006)

  • LV Diastolic indices:

    • E/A in AS (0.9±0.27) vs control (0.8±0.22) were significantly different (p=0.037)

4Nageeb G et al., 2013 [32]EgyptCase-control studyTTE

  • 45

  • Male: 38 (84%)

  • Female: 7 (16%)

  • 20

  • Male: N/A

  • Female: N/A

43.9±10.2N/A30.6±9.5

  • BASMI

  • >5 (24)

  • ≤5(23)

  • BASFI

  • >5(22)

  • ≤(23)

  • BASDAI

  • >5(22)

  • ≤5(23)

Tissue Doppler Imaging

  • LV Diastolic indices:

    • Em/Am in AS (0.88±0.2) vs control (1.3±0.16) was significantly different (p<0.01)

5Kocabas H et al., 2018 [25]TurkeyCase-control studyTTE

  • 35

  • Male: 26 (74%)

  • Female: 9 (26%)

  • 38

  • Male: 28 (74%)

  • Female: 10 (26%)

44.69±9.0343.13±8.5919.14±7.51

  • BASDAI

  • 3.81±2.79

  • BASFI

  • 3.69±2.79

  • BASMI

  • 9.34±2.51

  • ASQoL

  • 8.74±5.99

  • MASES

  • 1.43±2.23

Conventional Echocardiography

  • LV Systolic indices:

    • EF in AS (66.29±6.64) vs control (65.74±4.40) was found NS (p=0.376)

  • LV Diastolic indices:

    • E/A in AS (1.14±0.37) vs control (1.28±0.39) was found NS (p=0.120)

6Rosa RE et al., 2015 [10]BrazilCase-control studyTTE

  • 22

  • Male: 18 (82%)

  • Female: 4 (18%)

  • 22

  • Male: 14 (64%)

  • Female: 8 (36%)

38.9535.8516.45 (3–32)

  • BASDAI

  • 5.01±7.71

Conventional Echocardiography

  • LV Systolic indices:

    • EF in AS (67.55[60–77.2]) vs control (72.66[63–87]) was lower significantly (p=0.02)

  • Other Outcome:

    • Altered MPI correlated with disease duration =20 years (13.3%) vs >20 years (71.4%) was significantly different (p=0.014)

    • There was no significant (p=1) different of altered MPI in BASDAI<4 (25.0%) vs BASDAI>4 (35.7%)

7Seddik et al., 2023 [21]EgyptCase-control studyTTE

  • I = Inactive group

  • 57

  • Male: 21 (63.6%)

  • Female: 12 (36.4$)

  • II = Active group

  • 33

  • Male: 30 (52.6%)

  • Female: 27 (47.4%)

45

  • I = 34.7±5.31

  • II = 33.79±8.84

36.33±6.43

  • I = 5.72 ± 4.71

  • II = 7.21 ± 5.96

  • ASDAS

    I = 1.09±0.07

  • II = 3.46±0.51

Conventional Echocardiography

  • LV systolic indices:

    • •EF

    • I = 63.48±4.96

    • II = 65.75±5.66

    • Control = 66.76±5.24 (p=0.281)

8Moyssakis et al., 2009 [26]GreeceCase-control studyTTE

  • 57

  • Male: 54 (95%)

  • Female: 3 (5%)

  • 78

  • Female: 5 (6%)

  • Male: 73 (94%)

41.78 ± 10.0239.92 ± 9.1114.77 ± 10.07

  • BASDAI 1.24 ±1.13;

  • BASFI 2.89 ± 2.48; BASMI 5 ± 2.25

Conventional Echocardiography

  • LV systolic indices:

    EF in AS (59±5.7%) and control (62±4.6%) were similar (p=NS).

  • LV diastolic indices:

    E/A in AS (1.02±0.22) and control (1.11±0.25) were similar (p=NS).

  • Other Outcome:

    Correlation of LV Tei Index and disease duration (r=0.549, p<0.001)

    Correlation of LV Tei index and BASDAI score (r=0.405, p=0.004)

9Okan T et al., 2008 [30]TurkeyCase-control studyTTE

  • 49

  • Male: 25 (51%)

  • Female: 24 (49%)

  • 33

  • Male: 17 (51%)

  • Female: 16 (49%)

38±1136±9N/A

  • BASMI

  • (1.6±2.3)

  • BASFI

  • (2.5±2.5)

  • BASDAI

  • (3.5±2.0)

Conventional Echocardiography

  • LV systolic indices:

    EF in AS (65.0±4.4) vs control (65.0±3.9) (p=0.9)

  • LV diastolic indices:

    Peak E/A in AS (1.30±0.35) vs control (1.36±0.27) (p=0.5)

Tissue Doppler Imaging

  • LV diastolic indices:

    Peak E/A in AS (1.21±0.45) vs control (1.36±0.27) (p=0.05)

10Acar G et al., 2009 [20]Turkeycase-control studyTTE

  • 40

  • Male: 22 (55%)

  • Female: 18 (45%)

  • 42

  • Male: 22 (52%)

  • Female: 20 (48%)

37.82±10.2235.74±9.9869.48±63.85 (months)

  • BASFI

  • 1.48±1.46

  • BASDAI

  • 2.02±1.44

Conventional Echocardiography

  • LV systolic indices:

    EF in AS (66.55±4.87) vs control (67.02±4.68) (p=NS)

  • LV Diastolic indices:

    E/A in AS (1.21±0.30) vs control (1.40±0.28) (p=0.005)

11Kiris A et al., 2012 [31]Turkeycase-control studyTTE

  • 77

  • Male: 61 (79%)

  • Female: 16 (21%)

  • 40

  • Males: 35 (88%)

  • Female: 5 (12%)

36.4±1039.1±8.27.6±4.4

  • BASDAI

  • 2.8±0.9

Tissue Doppler Imaging

  • LV systolic indices:

    EF in AS (68.1±3.6) vs control (67.9±4.1) (p=0.75)

  • LV Diastolic indices:

    E/A in AS (1.4±0.4) vs control (1.6±0.41) (p=0.01)

Search Strategy

DatabaseQueryResults
MEDLINE(Spondylarthritis[MeSH Terms]) OR (Spondylitis, Ankylosing[MeSH Terms]) OR (Arthritis, Rheumatoid[MeSH Terms]) OR (Lupus Erythematosus, Systemic[MeSH Terms]) OR (Inflammatory Bowel Diseases[MeSH Terms]) OR (Dermatomyositis[MeSH Terms]) OR (Enteropathic Arthritis) OR (Inflammatory Bowel Disease Associated Arthropathy) OR (Polymyositis) OR (Connective Tissue Disease) OR (Rheumatic Autoimmune) OR (Autoinflammatory Disorders) OR (Systemic Autoimmune) OR (Sjogren Syndrome) OR (Systemic Sclerosis) OR (Inflammatory Arthritis)460,270
(Echocardiography[MeSH Terms]) OR (Ultrasonography, Doppler, Pulsed[MeSH Terms]) OR (Doppler Tissue Imaging) OR (Speckle Tracking Echocardiography)115,901
(Myocardial performance index) OR (Tei Index)11,964
#1 AND #2 AND #361
Google Scholar[((“Spondylarthritis” OR “Ankylosing Spondylitis” OR “Systemic Lupus Erythematosus” OR “Rheumatoid Arthritis” OR “Inflammatory Bowel Disease Related Arthritis” OR “Dermatomyositis” OR “Polymyositis” OR “Sjogren Syndrome” OR “Systemic Sclerosis”))] AND [((“Echocardiography” OR “ Doppler Pulsed Ultrasonography” OR “Doppler Tissue Imaging” OR “Speckle Tracking Echocardiography”))] AND [((“Myocardial performance index” OR “Tei Index”))]1010
ProQuest[((“Spondylarthritis” OR “Ankylosing Spondylitis” OR “Axial Spondyloarthritis” OR “ Peripheral Spondyloarthritis” OR “Rheumatoid Arthritis” OR “Systemic Lupus Erythematosus” OR “Inflammatory Bowel Disease-Related Arthritis” OR “Inflammatory Bowel Disease Associated Arthropathy” OR “Enteropathic Arthritis” OR “Dermatomyositis” OR “Polymyositis” OR “Sjogren Syndrome” OR “Systemic Sclerosis” OR “Connective Tissue Disease” OR “Inflammatory Arthritis” OR “Rheumatic Autoimmune” OR “Autoinflammatory Disorders” OR “Systemic Autoimmune”))]1047
[((“Echocardiography” OR “ Doppler Pulsed Ultrasonography” OR “Doppler Tissue Imaging” OR “Speckle Tracking Echocardiography”))]1061
[((“Myocardial performance index” OR “Tei Index”))]1181
#1 AND #2 AND #3270
Scopus(spondylarthritis [mesh AND terms]) OR (spondylitis, AND ankylosing [mesh AND terms] OR (arthritis, AND rheumatoid [mesh AND terms]) OR (lupus AND erythematosus, AND systemic [mesh AND terms]) OR (inflammatory AND bowel AND disease-related AND arthritis [mesh AND terms]) OR (inflammatoryAND bowel AND disease AND associated AND arthropathy [mesh AND terms]) OR (enteropathic AND arthritis) OR (dermatomyositis [mesh AND ters]) OR (polymyositis) OR (sjogren AND syndrome) OR (systemic AND sclerosis) OR (connective AND tissue AND disease) OR (inflammatory AND arthritis) OR (rheumatic AND autoimmune) OR (autoinflammatory AND disorders) OR (systemic AND autoimmune)1,110,802
(echocardiography [mesh AND terms]) OR (ultrasonography, AND doppler, AND pulsed [mesh AND terms]) OR (doppler AND tissue AND imaging) OR (speckle AND tracking AND echocardiography)125,326
[((“Myocardial performance index” OR “Tei Index”))]221,690
1 AND #2 AND #3896
Cochrane Library(Spondylarthritis[MeSH Terms]) OR (Spondylitis, Ankylosing[MeSH Terms]) OR (Arthritis, Rheumatoid[MeSH Terms]) OR (Lupus Erythematosus, Systemic[MeSH Terms]) OR (Inflammatory Bowel Diseases[MeSH Terms]) OR (Dermatomyositis[MeSH Terms]) OR (Enteropathic Arthritis) OR (Inflammatory Bowel Disease Associated Arthropathy) OR (Polymyositis) OR (Connective Tissue Disease) OR (Rheumatic Autoimmune) OR (Autoinflammatory Disorders) OR (Systemic Autoimmune) OR (Sjogren Syndrome) OR (Systemic Sclerosis) OR (Inflammatory Arthritis)14570
(Echocardiography[MeSH Terms]) OR (Ultrasonography, Doppler, Pulsed[MeSH Terms]) OR (Doppler Tissue Imaging)66
(Myocardial performance index) OR (Tei Index)227
#1 AND #2 AND #32
DOI: https://doi.org/10.2478/rjim-2025-0013 | Journal eISSN: 2501-062X | Journal ISSN: 1220-4749
Journal RSS Feed
Language: English
Page range: 191 - 208
Submitted on: Dec 19, 2024
Published on: Jul 12, 2025
Published by: N.G. Lupu Internal Medicine Foundation
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
Ankylosing Spondylitis,
Cardiac Dysfunction,
Myocardial Performance Index,
Spondyloarthritis,
Tei Index
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Internal medicine, other,
Cardiology,
Gastroenterology,
Rheumatology

© 2025 Steven Alvianto, Faisal Parlindungan, Naomi Niari Dalimunthe, Nicolas Daniel Widjanarko, Yovita Gotama, Ummi Kultsum, Cristopher Efendi, published by N.G. Lupu Internal Medicine Foundation
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

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