Is diastolic dysfunction associated with atrial electrocardiographic parameters in Behçet's disease? (original) (raw)
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Clinical Rheumatology, 2006
Behcet's disease (BD) is a systemic vasculitis characterized by genital and oral ulcers, uveitis, and other organs' involvement. Left ventricular (LV) diastolic dysfunction has been documented in BD. However, conventional echocardiographic techniques have serious limitations like its dependence on preload, afterload and heart rate. Recently, new techniques like colour M-mode and tissue Doppler imagining (TDI) have provided additional concept in the assessment of diastolic function. The aim of the present study was to investigate the LV diastolic dysfunction with conventional and new echocardiographic techniques in BD. Forty-eight patients with BD (25 women, 23 men) and 26 healthy volunteers (15 women, 11 men) were enrolled in the study. LV diastolic functions were examined with mitral inflow pulse wave Doppler, TDI and mitral flow propagation rate (MFPR). The following were accepted as diastolic dysfunction: in mitral inflow pulse wave Doppler, E/A<1, isovolumic relaxation time (IVRT) >110 ms and deceleration time of E wave (DT)>240 ms; in TDI of mitral ring with pulse wave, E ′/A′<1; and in MFPR, velocity slope (Vp)<45 cm/s. The two groups were comparable in age, sex, heart rate, body mass index, smoking, hyperlipidemia and basic echocardiographic measure-ments. LV diastolic dysfunction was significantly higher in BD group according to E/A<1 (p<0.05). When echocardiographic measurements were compared one by one for two groups, As' (late diastolic TDI wave in septal wall) was found to be significantly higher in BD group (p<0,0001). IVRT was longer in BD group than in controls, but it did not reach statistical significance (p=0,06). Diastolic dysfunction of LV is more frequent in patients with BD than in control according to E/A and As′. Conventional and current techniques like TDI and colour M-mode Doppler echocardiography could be used to investigate diastolic functions in BD.
International Journal of Rheumatology, 2016
Background. Cardiovascular involvement in Behcet’s disease (BD) is reported and has variable manifestations. It is not clear if diastolic dysfunction (DD) is increased in BD. Our objective was to evaluate the existing literature to determine if cardiac dysfunction, particularly DD, was more prevalent in these patients.Methods. A systematic review and meta-analysis of the available studies analyzing the echocardiographic findings in BD was conducted using a random-effects model. Mean differences were used to calculate the effect sizes of the echocardiographic parameters of interest.Results. A total of 22 studies with 1624 subjects were included in the analysis. Patients with BD had statistically significantly larger mean left atrial dimension (0.08,p=0.0008), greater aortic diameter (0.16,p=0.02), significantly reduced ejection fraction (−1.08,p<0.0001), significantly prolonged mitral deceleration time (14.20,p<0.0001), lowerE/Aratio (−0.24,p=0.05), and increased isovolumetric ...
Clinical Rheumatology, 2008
Vascular involvement is one of the major characteristics of Behcet's disease (BD). However, there are controversial findings regarding cardiac involvement in BD. Although early reports demonstrated that there is diastolic dysfunction in BD, conflicting results were found in the following trials. Hence, a new method for more objectively estimating the cardiac functions is needed. For this aim, we used high-usefulness tissue Doppler echocardiography for detailed analysis of cardiac changes in BD patients because this method was superior to other conventional echocardiographic techniques. The study population included 42 patients with BD (19 men, 23 women; mean age, 35±10 years, mean disease duration, 2.7±1.6 years) and 30 healthy subjects (14 men, 16 women; mean age, 38±7 years). Cardiac functions were determined using echocardiography, comprising standard two-dimensional and conventional Doppler and tissue Doppler imaging (TDI). Peak systolic myocardial velocity at mitral annulus, early diastolic mitral annular velocity (Em), late diastolic mitral annular velocity (Am), Em/Am, and myocardial performance index (MPI) were calculated by TDI. The conventional echocardiographic parameters and tissue Doppler measurements were similar between the groups. Tissue Doppler derived mitral relaxation time was longer (75±13 vs 63±16 msn, p=0.021) in patients with BD. There was statistically significant difference between the two groups regarding left ventricular MPI (0.458±0.072 vs 0.416±0.068%, p=0.016), which were calculated from tissue Doppler systolic time intervals. There was also significant correlation between the disease duration and MPI (r=0.38, p=0.017). We have demonstrated that tissue Doppler-derived myocardial left ventricular relaxation time and MPI were impaired in BD patients, although systolic and diastolic function parameters were comparable in the patients and controls.
Echocardiographic Findings in Patients With Behçet’s Disease
The American Journal of Cardiology, 2006
Behçet's disease. However, there are no data evaluating the value of Doppler tissue imaging (DTI) in Behçet's disease. The aim of this study was to evaluate the cardiac involvement and the LV function at rest and at the end of isometric exercise by pulse-wave Doppler and DTI methods in patients with Behçet's disease. Fifty-four patients with Behcet's disease and 50 control subjects were studied. Dimensions of cardiac chambers, aortic root dimension, valvular abnormalities, and systolic function were similar in both groups. The mean E/A ratio was significantly lower in patients than controls (1.22 ؎ .09 vs 1.36 ؎ 0.30, p ؍ 0.01). The E/A ratio was <1 in 12 patients (22%) and in 3 controls (6%) (p ؍ 0.02). By DTI, no difference was found in the mean S-, e-, and a-wave velocities, and e/a ratio between the 2 groups. The e/a ratio was <1 in 13 patients (24.1%) and in 7 controls (14%) (p ؍ 0.2) by DTI. There were no differences in the mitral pulse-wave Doppler and DTI parameters in patient and control groups at the end of exercise. The prevalence of cardiac pathology in Behçet's disease did not differ appreciably from the controls. In conclusion, the LV systolic and diastolic functions in the patients with Behçet's disease and controls were similar not only at rest but also at the end of exercise.
Doppler evaluation of left ventricular diastolic filling in Beh�et's disease
Int J Cardiol, 1994
Although cardiac involvement such as pericarditis, myocarditis. coronary arteritis and valvular disease in BehGet's disease occurs, few studies have assessed left ventricular diastolic function. This study assesses the prevalence of both systolic and diastolic left ventricular dysfunction in patients with Behcet's disease who have no clinical cardiac manifestations. Twenty-two patients (12 women and 10 men, mean age 34 l 2.4 years) underwent full clinical examination, electrocardiography, M-mode, two-dimensional, and Doppler echocardiography. The mean disease duration was 5 * 4.7 years (range, I month-16 years). An age and sex-matched control group of 20 healthy subjects was also studied. Prolonged isovolumic relaxation time, prolonged deceleration time, reversal of the early and late peak transmitral diastolic flow velocities, late peak transmitral diastolic flow velocities (E/A ratio) and increased atrial filling fraction were noted in five patients. It is concluded that left ventricular dysfunction occurs frequently in patients with BehGet's disease and Doppler echocardiography may be valuable in detecting diastolic filling abnormalities as an early sign of cardiac involvement.
Cardiovascular involvement in Behçet’s disease
Clinical Rheumatology, 2010
Objectives: This study aims to evaluate left and right ventricular functions at rest by pulsed-wave Doppler and tissue Doppler echocardiography methods in patients with Behçet's disease (BD) without overt cardiovascular disease, and compare with age and sex matched subjects. Patients and methods: Fifty-four patients with BD (12 males, 42 females; mean age 35±8 years; range 18 to 51 years) without cardiovascular symptoms, and 36 age-matched controls (12 males, 24 females; mean age 33±5 years; range 18 to 47 years) were included. Cardiac functions were evaluated by conventional and tissue Doppler echocardiography. Results: Although conventional indices of left ventricular systolic function were similar in both groups, mitral annular systolic velocity was lower (p<0.001) and myocardial performance index was higher (p<0.001) in patients with BD compared to the controls. As an early diagnostic marker of contractile dysfunction, intra-and interventricular dyssynchrony were more common in patients with BD. In addition, mitral E/A ratio of <1 was more common (p<0.001), isovolumic relaxation time (p=0.032) and mitral deceleration time (p=0.037) were longer in patients with BD compared to the control group. All Doppler parameters of right ventricular function were impaired in patients with BD. Atrial septal aneurysm was more frequent in patients with BD than controls (p=0.007). Conclusion: Right ventricular and left ventricular function is impaired in patients with BD. Clinically silent cardiovascular involvement can be detected early by tissue Doppler echocardiography even in asymptomatic patients with BD.
Doppler evaluation of left ventricular diastolic filling in Behçet's disease
International Journal of Cardiology, 1994
To assess left ventricular (LV) diastolic function in children with systemic hypertension, 11 patients with hypertension (mean blood pressure 99 mm Hg) and 7 normal patients (mean blood pressure 78 mm Hg) underwent M-mode echocardiography and pulsed Doppler examination of the LV inflow. From a digitized trace of the LV endocardium and a simultaneous phonocardiogram, echocardiographic diastolic time intervals, peak rate of increase in LV dimension (dD/dt), and dD/dt normalized for LV end-diastolic dimension (dD/dt/D) were measured. Doppler diastolic time intervals, peak velocities at rapid filling (E velocity) and atrial contraction (A velocity), and the ratio of E and A velocities were measured. The following areas under the Doppler curve and their percent of the total area were determined:
European Journal of Echocardiography, 2011
The aim of this study was to evaluate the left ventricular (LV) systolic strain by speckle tracking echocardiography (STE) in order to provide the early detection of myocardial dysfunction in patients with Behcet's disease (BD). We also aimed to examine the relationship between LV systolic strain and N-terminal pro-B type natriuretic peptide (NT-proBNP), which is a cardiac biomarker of ventricular dysfunction. Methods and results Longitudinal and circumferential systolic strain assessed by STE was obtained in 32 BD patients and 27 age-matched controls. NT-proBNP levels were also measured in all subjects. Regional and mean longitudinal strain (217.8 + 2.7 vs. 220.5 + 1.8%; P , 0.0001) was significantly lower in BD patients when compared with the healthy controls. Whereas regional and mean circumferential strain values (222.0 + 1.6 vs. 222.2 + 2.3%; P ¼ 0.62) did not reveal a significant difference between the patients and the controls. NT-proBNP was significantly higher in the patients than in the controls (65.18 + 84.51 vs. 30.84 + 14.75 pg/mL; P ¼ 0.003). Linear regression analyses revealed only NT-proBNP as the independent correlate of mean LV longitudinal strain (R ¼ 0.603, P ¼ 0.001). Conclusion Longitudinal myocardial systolic function assessed by STE, which is a sensitive marker of subclinical ventricular dysfunction is impaired in BD. Increased NT-proBNP levels may be a sign of subclinical ventricular dysfunction in these patients.
Left ventricular mechanics in Behcet’s disease: A speckle tracking echocardiographic study
Bosnian Journal of Basic Medical Sciences, 2014
Although cardiac involvement is rarely seen in Behcet' s disease (BD), it is essential to detect subclinical left ventricular (LV) dysfunction for prognostic purposes. Herein we aimed to show the role of two dimensional (2D) speckle tracking echocardiography (STE) in determination of subclinical LV dysfunction in patients with BD. 30 patients diagnosed as BD due to International Study Group Behcet' s diagnostic criteria and 25 control subjects underwent Doppler echocardiography including pulsed tissue Doppler of the mitral annulus and speckle-tracking echocardiography. LV peak longitudinal strain and strain rate (SR) was calculated in four-chamber (4C), apical long-axis (LAX), and two-chamber (2C) views, and values of the three views were averaged LV global longitudinal strain (LV-GLS) and SR. LV torsion was determined as the net difference in the mean rotation between the apical and basal levels. There was not any significant difference in age and gender between groups. Patients with BD had significantly lower LV longitudinal strain and Sr measurements than the control group. Although LV basal rotation (LVR) basal values were similar in both groups, LVR-apical and LV torsion (LVTR) values were significantly higher in patient group. LVR-apical and LV-GLS were found to have a good positive corelation (r: 0.44, p<0.001) (r:-0.56, r:-0.65, respectively. p<0.001). There was a weak positive correlation between LVTR and LV-GLS (r: 0.29, p<0.05). We demonstrated that combined assessment of LV-GLS, LV-GLSR, LVTR and LVRapical values detected by STE can be useful in determination of subclinical left ventricular dysfunction in BD.
Cardiac findings in Behçet’s patients
International Journal of Dermatology, 2010
Behçet's disease is a chronic multi-system inflammatory disorder and the severity and clinical manifestations of Behçet's patients may show geographic variation. We aimed to detect the cardiac findings in 30 Behçet's patients and compare them with the normal population (n = 29). We used color-doppler echocardiography and transesophageal echocardiography in combination. We calculated manually QT intervals and QT dispersion (QTd) from twelvelead ECG recordings. There was no E/A inversion and coronary ischemia in all patients or control group. The E velocity difference between groups was not significant. The mean A velocity was significantly lower in Behçet's patients than normal group. The mean DT was 154.4 ± 5.8 msec in Behçet's patients and 122.59 ± 0.96 msec in control group (P < 0.0001). The mean IVRT was 75.66 ± 1.36 msec in Behçet's patients and 69.1 ± 0.55 msec in control group (P < 0.0001). There was no QTc time difference between the Behçet's patients and the control group. The mean QT dispersion (QTd) interval was 45.46 ± 2.65 msec in Behçet's patients and 31.83 ± 1.23 msec in control group (P < 0.0001). Atrial septal aneurysm, mitral valve prolapse and insufficiency, tricuspid valve insufficieny, and pulmonary hypertension frequencies in Behçet's patients were significantly higher than in the control group. We concluded that Behçet's cardiac involvement may effect cardiac structure and cause diastolic dysfunction, electrical instability and structural abnormalities. We also concluded that cardiac involvement in Behçet's disease may be specific for this geographic area.