Abstract
Objective: Behçet's disease (BD) is a chronic inflammatory disease with multiple organ involvements. Although cardiac involvement is not common, it can increase patient morbidity and mortality and decrease life quality. In the present study, echocardiographic abnormalities in BD with no cardiac symptoms were investigated.
Methods: This cross-sectional descriptive-analytic study was performed on patients referred to Imam Reza Hospital in Mashhad from 2015 to 2018. The participants were divided into control and BD groups. Patients with BD were diagnosed based on ISG criteria. All participants underwent transthoracic echocardiography. Echocardiographic parameters were compared between BD and control groups.
Results: In this study, the severity of aortic (AR), mitral (MR), and tricuspid valve regurgitation (TR) was higher in BD than in the control group, while only TR severity showed a statistically significant difference (p-value < 0.001). Systolic Pulmonary Artery Pressure (sPAP) was significantly higher in BD compared to the control group (24.6 mmHg versus 22.81 mmHg, respectively) (pvalue = 0.019).
Conclusion: It seems echocardiography is valuable in evaluating a cardiac function, even in asymptomatic patients. Cases with moderate mitral and aortic regurgitation were only observed in BD. Long-term follow-up is suggested, and further studies are required.
Keywords: Behçet's disease (BD), echocardiography, systolic pulmonary artery pressure (sPAP), RHC, thrombosis.
Graphical Abstract
[1]
Davatchi F, Shahram F, Chams-Davatchi C, et al. Behcet’s disease: From east to west. Clin Rheumatol 2010; 29(8): 823-33.
[http://dx.doi.org/10.1007/s10067-010-1430-6] [PMID: 20354748]
[http://dx.doi.org/10.1007/s10067-010-1430-6] [PMID: 20354748]
[2]
Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Eds. Harrisons principles of internal medicine. (19th ed.). New York: McGraw Hill 2015; 2: p. 2194.
[3]
Behçet H, Matteson EL. On relapsing, aphthous ulcers of the mouth, eye and genitalia caused by a virus. 1937. Clin Exp Rheumatol 2010; 28(4) (Suppl. 60): S2-5.
[PMID: 20868561]
[PMID: 20868561]
[4]
Curth HO. Recurrent genito-oral aphthosis and uveitis with hypopyon (Behcet’s syndrome). Arch Derm Syphilol 1946; 54(2): 179-96.
[http://dx.doi.org/10.1001/archderm.1946.01510370063005] [PMID: 20995035]
[http://dx.doi.org/10.1001/archderm.1946.01510370063005] [PMID: 20995035]
[5]
Davatchi F. Diagnosis/classification criteria for Behcet’s disease. Pathol Res Int 2012; 2012: 607921.
[http://dx.doi.org/10.1155/2012/607921] [PMID: 21961081]
[http://dx.doi.org/10.1155/2012/607921] [PMID: 21961081]
[6]
Saadoun D, Wechsler B. Behçet’s disease. Orphanet J Rare Dis 2012; 7(1): 20.
[http://dx.doi.org/10.1186/1750-1172-7-20] [PMID: 22497990]
[http://dx.doi.org/10.1186/1750-1172-7-20] [PMID: 22497990]
[7]
Poon W, Verity DH, Larkin GL, Graham EM, Stanford MR. Behçet’s disease in patients of west African and Afro-Caribbean origin. Br J Ophthalmol 2003; 87(7): 876-8.
[http://dx.doi.org/10.1136/bjo.87.7.876] [PMID: 12812890]
[http://dx.doi.org/10.1136/bjo.87.7.876] [PMID: 12812890]
[8]
Ahmad T, Zhang L, Gogus F, et al. CARD15 polymorphisms in Behçet’s disease. Scand J Rheumatol 2005; 34(3): 233-7.
[http://dx.doi.org/10.1080/03009740510018714] [PMID: 16134731]
[http://dx.doi.org/10.1080/03009740510018714] [PMID: 16134731]
[9]
Kaufman WS, Kaufman ME, Jorizzo JL. Behcet’s disease.Firestein GS, Budd RC, Gabriel SE McInnes IB, O'Dell JR, Eds. Kelley’s Textbook of Rheumatology 9th ed. Philadelphia: Elsevier Health Sciences 2013; pp. 1525-32.
[http://dx.doi.org/10.1016/B978-1-4377-1738-9.00093-1]
[http://dx.doi.org/10.1016/B978-1-4377-1738-9.00093-1]
[10]
Azizlerli G, Köse AA, Sarica R, et al. Prevalence of Behçet’s disease in Istanbul, Turkey. Int J Dermatol 2003; 42(10): 803-6.
[http://dx.doi.org/10.1046/j.1365-4362.2003.01893.x] [PMID: 14521694]
[http://dx.doi.org/10.1046/j.1365-4362.2003.01893.x] [PMID: 14521694]
[11]
Cakir N, Dervis E, Benian O, et al. Prevalence of Behçet’s disease in rural western Turkey: A preliminary report. Clin Exp Rheumatol 2004; 22(4) (Suppl. 34): S53-5.
[PMID: 15515786]
[PMID: 15515786]
[12]
Davatchi F, Jamshidi AR, Banihashemi AT, et al. WHO-ILAR-COPCORD study (stage 1, urban study) in Iran. J Rheumatol 2008; 35(7): 1384-90.
[PMID: 18464299]
[PMID: 18464299]
[13]
Moghimi N, Davatchi F, Rahimi E, et al. WHO-ILAR COPCORD study (stage 1, urban study) in Sanandaj, Iran. Clin Rheumatol 2015; 34(3): 535-43.
[http://dx.doi.org/10.1007/s10067-013-2430-0] [PMID: 24213781]
[http://dx.doi.org/10.1007/s10067-013-2430-0] [PMID: 24213781]
[14]
Benamour S, Naji T, Echchilali K. Study of 1034 cases of Behcet’s disease. Clin Exp Rheumatol 2005; 24 (Suppl. 42): S13.
[15]
Jokar M, Mirfeizi Z. Epidemiology of vasculitides in khorasan province, Iran. Iran J Med Sci 2015; 40(4): 362-6.
[PMID: 26170524]
[PMID: 26170524]
[16]
Direskeneli H. Behçet’s disease: Infectious aetiology, new autoantigens, and HLA-B51. Ann Rheum Dis 2001; 60(11): 996-1002.
[http://dx.doi.org/10.1136/ard.60.11.996] [PMID: 11602462]
[http://dx.doi.org/10.1136/ard.60.11.996] [PMID: 11602462]
[17]
Verity DH, Marr JE, Ohno S, Wallace GR, Stanford MR. Behçet’s disease, the Silk Road and HLA-B51: Historical and geographical perspectives. Tissue Antigens 1999; 54(3): 213-20.
[http://dx.doi.org/10.1034/j.1399-0039.1999.540301.x] [PMID: 10519357]
[http://dx.doi.org/10.1034/j.1399-0039.1999.540301.x] [PMID: 10519357]
[18]
Zouboulis CC. Epidemiology of Adamantiades-Behçet’s disease. Ann Med Interne 1999; 150(6): 488-98.
[PMID: 10615535]
[PMID: 10615535]
[19]
Lehner T. The role of heat shock protein, microbial and autoimmune agents in the aetiology of Behçet’s disease. Int Rev Immunol 1997; 14(1): 21-32.
[http://dx.doi.org/10.3109/08830189709116842] [PMID: 9203024]
[http://dx.doi.org/10.3109/08830189709116842] [PMID: 9203024]
[20]
Mirfeizi Z, Tabaei S, Ravanshad Y, Hashemzadeh K, Kharazmi E, Mehrad-Majd H. Associations between vitamin D receptor polymorphisms and susceptibility to Behcet’s disease: A meta-analysis. Immunol Invest 2018; 47(4): 389-402.
[http://dx.doi.org/10.1080/08820139.2018.1430827] [PMID: 29388852]
[http://dx.doi.org/10.1080/08820139.2018.1430827] [PMID: 29388852]
[21]
Bletry O, Mohattane A, Wechsler B, et al. Cardiac involvement in Behçet’s disease. 12 cases. Presse Med 1988; 17(45): 2388-91.
[PMID: 2974981]
[PMID: 2974981]
[22]
Davachi F, Assad-khalil S, Calamia KT, et al. International Team for the Revision of the International Criteria for Behcets Disease (ITR-ICBD). The International Criteria for Behcets Disease (ICBD): A collaborative study of 27 countries on the sensitivity and the specificity of the new criteria. J Eur Acad Dermatol Venereol 2014; 28(3): 338-47.
[http://dx.doi.org/10.1111/jdv.12107] [PMID: 23441863]
[http://dx.doi.org/10.1111/jdv.12107] [PMID: 23441863]
[23]
Karabag T, Aydin M, Dogan SM, et al. Investigation of the atrial electromechanical delay duration in Behcet patients by tissue Doppler echocardiography. Eur Heart J Cardiovasc Imaging 2012; 13(3): 251-6.
[http://dx.doi.org/10.1093/ejechocard/jer227] [PMID: 22048981]
[http://dx.doi.org/10.1093/ejechocard/jer227] [PMID: 22048981]
[24]
Özkan M, Emel O, Özdemir M, et al. M-mode, 2-D and Doppler echocardiographic study in 65 patients with Behçet’s syndrome. Eur Heart J 1992; 13(5): 638-41.
[http://dx.doi.org/10.1093/oxfordjournals.eurheartj.a060228] [PMID: 1618206]
[http://dx.doi.org/10.1093/oxfordjournals.eurheartj.a060228] [PMID: 1618206]
[25]
Tu¨zu¨n H, Sayin A, Karao¨zbek Y. Peripheral aneurysms in Behcet’s disease. Cardiovasc Surg 1993; 1: 220e4.
[26]
Ko SH, Kang SK, Lee SK, Song HS. Massive thrombosis after central venous catheterization in a patient with previously undiagnosed Behcet’s disease. J Korean Med Sci 2001; 16: 814e6.
[27]
Chang JE, Lee YH, Lee J. Multiple cardiovascular complications in a patient with Behcet’s disease. Korean J Intern Med 2008; 23(2): 100-2.
[http://dx.doi.org/10.3904/kjim.2008.23.2.100] [PMID: 18646513]
[http://dx.doi.org/10.3904/kjim.2008.23.2.100] [PMID: 18646513]
[28]
Bowles CA, Nelson AM, Hammill SC, O’Duffy JD. Cardiac involvement in Behçet’s disease. Arthritis Rheum 1985; 28(3): 345-8.
[http://dx.doi.org/10.1002/art.1780280317] [PMID: 3977978]
[http://dx.doi.org/10.1002/art.1780280317] [PMID: 3977978]
[29]
Wan SH, Vogel MW, Chen HH. Pre-clinical diastolic dysfunction. J Am Coll Cardiol 2014; 63(5): 407-16.
[http://dx.doi.org/10.1016/j.jacc.2013.10.063] [PMID: 24291270]
[http://dx.doi.org/10.1016/j.jacc.2013.10.063] [PMID: 24291270]
[30]
Mirfeizi Z, Memar B, PourZand H, Molseghi MH, Shahmirzad RA, Abdollahi N. Ventricular endomyocardial fibrosis in a pregnant female with Behçet’s disease. Asian Cardiovasc Thorac Ann 2018; 26(8): 619-21.
[http://dx.doi.org/10.1177/0218492316687177] [PMID: 28068787]
[http://dx.doi.org/10.1177/0218492316687177] [PMID: 28068787]
[31]
Correa de Sa DD, Hodge DO, Slusser JP, et al. Progression of preclinical diastolic dysfunction to the development of symptoms. Heart 2010; 96(7): 528-32.
[http://dx.doi.org/10.1136/hrt.2009.177980] [PMID: 20350989]
[http://dx.doi.org/10.1136/hrt.2009.177980] [PMID: 20350989]
[32]
Adrovic A, Dedeoglu R, Sahin S, et al. Evaluation of pulmonary artery pressure in patients with Juvenile Systemic Lupus Erythematosus (jSLE). Bosn J Basic Med Sci 2018; 18(1): 66-71.
[PMID: 28704174]
[PMID: 28704174]
[33]
Akdogan A, Kilic L, Dogan I, et al. Pulmonary hypertension in systemic lupus erythematosus: Pulmonary thromboembolism is the leading cause. J Clin Rheumatol 2013; 19(8): 421-5.
[http://dx.doi.org/10.1097/RHU.0000000000000037] [PMID: 24263143]
[http://dx.doi.org/10.1097/RHU.0000000000000037] [PMID: 24263143]
[34]
Udayakumar N, Venkatesan S, Rajendiran C. Pulmonary hypertension in rheumatoid arthritis-relation with the duration of the disease. Int J Cardiol 2008; 127(3): 410-2.
[http://dx.doi.org/10.1016/j.ijcard.2007.04.084] [PMID: 17689710]
[http://dx.doi.org/10.1016/j.ijcard.2007.04.084] [PMID: 17689710]
[35]
Sugiura T, Kamioka M, Yamanaka S, Hisahara T, Hirakawa Y, Matsumura Y. Relationship between matrix metalloproteinase-3 serum level and pulmonary artery systolic pressure in patients with rheumatoid arthritis. Heart Vessels 2018; 33(2): 191-7.
[http://dx.doi.org/10.1007/s00380-017-1045-9] [PMID: 28828748]
[http://dx.doi.org/10.1007/s00380-017-1045-9] [PMID: 28828748]
[36]
Weatherald J, Montani D, Jevnikar M, Jaïs X, Savale L, Humbert M. Screening for pulmonary arterial hypertension in systemic sclerosis. Eur Respir Rev 2019; 28(153): 190023.
[http://dx.doi.org/10.1183/16000617.0023-2019] [PMID: 31366460]
[http://dx.doi.org/10.1183/16000617.0023-2019] [PMID: 31366460]
[37]
Kobak S, Kalkan S, Kirilmaz B, Orman M, Ercan E. Pulmonary arterial hypertension in patients with primary Sjogren’s syndrome. Autoimmune Dis 2014; 2014: 710401.
[http://dx.doi.org/10.1155/2014/710401] [PMID: 24511390]
[http://dx.doi.org/10.1155/2014/710401] [PMID: 24511390]
[38]
Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American society of echocardiography and the European association of cardiovascular imaging. J Am Soc Echocardiogr 2015; 28(1): 1-39.e14.
[http://dx.doi.org/10.1016/j.echo.2014.10.003] [PMID: 25559473]
[http://dx.doi.org/10.1016/j.echo.2014.10.003] [PMID: 25559473]
[39]
Ehrlich GE. Vasculitis in Behçet’s disease. Int Rev Immunol 1997; 14(1): 81-8.
[http://dx.doi.org/10.3109/08830189709116846] [PMID: 9203028]
[http://dx.doi.org/10.3109/08830189709116846] [PMID: 9203028]
[40]
Ulusan Z, Karadag AS, Tasar M, Kalender M, Darcin OT. Behcet’s disease and cardiovascular involvement: Our experience of asymptomatic Behcet’s patients. Cardiovasc J S Afr 2014; 25(2): 63-6.
[http://dx.doi.org/10.5830/CVJA-2014-003] [PMID: 24844550]
[http://dx.doi.org/10.5830/CVJA-2014-003] [PMID: 24844550]
Article Metrics
1