Ankylosing spondylitis (AS) associates with various cardiac lesions, including aortitis/aortic regurgitation, conduction abnormalities and myocardial involvement, due to either coronary artery disease or primary cardiomyopathy.1 The cornerstone tool for the non-invasive evaluation of heart involvement has, until recently, been echocardiography.1 Echocardiographic evaluation in AS is mainly focused on valve and ventricular function assessment, with the pattern of ‘diastolic dysfunction with preserved ejection fraction’ being the most common preclinical finding. A strong correlation has also been shown between several indices of vascular pathology associated with the development of cardiovascular disease (CVD) and increased disease activity in patients with AS.2

Cardiovascular magnetic resonance (CMR), a non-invasive, non-radiating, operator-independent technique, currently represents the gold standard for ventricular function and tissue characterisation in patients with CVD, including those in whom CVD develops in the context of a connective tissue disease (CTD).3 ,4 Recently, new CMR indices, such as native and postcontrast T1 mapping, T2 mapping and extracellular volume quantification (ECV) have been successfully used to identify preclinical cardiac lesions …