Abstract
BackgroundBehçet’s disease (BD) is a multisystemic vasculitis that may affect the heart. However, the incidence and nature of cardiac involvement in BD have not been clearly documented yet. The aim of this study was to delineate the cardiac magnetic resonance imaging (MRI) appearances of cardiac involvement in BD patients.MethodsThis cross-sectional observational study was carried out 30 BD patients without known cardiac disease. Patients were subjected to history taking, physical examination, echocardiography and cardiac MRI.ResultsAt least one abnormality on cardiac MRI was observed in 20/30 patients (66.67%). Myocardial oedema was observed in 3 patients (10%) and late gadolinium enhancement in 1 patient (3.3%). Pericardial effusion was found in 3 patients (10.0%), global hypokinesia in 6 patients (20.0%) and intra-cardiac thrombosis in only 1 patient (3.3%). Pulmonary artery was dilated in 4 patients (13.3%). Left ventricular (LV) and right ventricular (RV) end diastolic volume were altered in 4 patients (13.3%) and 7 patients (23.3%) respectively. LV and RV end systolic volume were abnormal in 7 patients (23.3%) and 5 patients (16.7%) respectively. There was aortic valve regurge in 2 patients (6.7%), tricuspid valve regurge in 9 patients (30%), and mitral valve regurge in 9 patients (30%). Dilated left main coronary artery was found in 2 patients (6.7%) and arrhythmogenic right ventricular dysplasia in only one patient 1 patient (3.3%). On logistic regression analysis, BD activity index score was a significant predictor of cardiac abnormalities.ConclusionBD may cause cardiac abnormalities without clinical manifestations and cardiac MRI may represent a tool for early detection of these subtle abnormalities. Higher BD activity index scores are strongly linked to cardiac problems.
Highlights
Behçet’s disease (BD) is a multisystemic vasculitis that may affect the heart
Cardiac magnetic resonance imaging (MRI) evaluation Cardiac MRI showed at least one abnormality in 25 (83.33%) of the studied 30 BD patients
Echocardiography versus cardiac MRI in detecting cardiac abnormalities When we explored the performance of echocardiography in heart evaluation compared to cardiac MRI in BD patients, the results showed sensitivity of 64%, specificity of 100%, positive predictive value (PPV) of 100%, negative predictive value of 37.5% and accuracy of 70%
Summary
Behçet’s disease (BD) is a multisystemic vasculitis that may affect the heart. The incidence and nature of cardiac involvement in BD have not been clearly documented yet. The exact pathogenesis is still unknown, but it is a multifactorial disease classified as vasculitis. It may be BD was first described as a trisymptom complex of recurrent oral and genital ulcers and uveitis [4] and later recognized as a multisystem disease with neurological, pulmonary, gastrointestinal, musculoskeletal, vascular and cardiac involvement [5]. Cardiac involvement is rare and underestimated [6]. All cardiac layers may be involved resulting in pericarditis, myocarditis, endocarditis, intracardiac thrombosis and valvular disease [7].
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