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Evaluation of diastolic dysfunction and repolarization dispersion in Behcet's disease
1Department of Cardiology, University of Uludag, School of Medicine, Görükle 16059, Bursa, Turkey. kari@uludag.edu.tr
Insights
Behcet's disease patients show increased diastolic dysfunction and repolarization dispersion, particularly QT dispersion. These findings suggest a link between impaired heart relaxation and electrical instability in Behcet's disease patients.
Area of Science:
- Cardiology
- Rheumatology
- Internal Medicine
Background:
- Behcet's disease is a systemic inflammatory disorder with known cardiovascular manifestations.
- Recent studies indicate potential for left ventricular diastolic dysfunction, arrhythmias, and sudden cardiac death in Behcet's disease.
Purpose of the Study:
- To investigate left ventricular systolic and diastolic function, valvular and ischemic heart disease, and repolarization dispersion in Behcet's disease patients.
- To compare these cardiac parameters between Behcet's disease patients and a control group.
Main Methods:
- Echocardiography (M-mode, 2-D, Doppler) assessed ventricular function and structure.
- Exercise stress tests and myocardial perfusion scintigraphy evaluated ischemia.
- Repolarization dispersion was measured using QT dispersion from 12-lead ECGs during stress tests.
Main Results:
- Behcet's patients exhibited significantly higher rates of diastolic dysfunction (lower E/A ratio, longer isovolumic relaxation time and mitral deceleration time) compared to controls.
- QT dispersion was significantly increased in Behcet's patients versus controls.
- A significant correlation was found between diastolic dysfunction and increased QT dispersion in Behcet's patients.
Conclusions:
- Behcet's disease is associated with a high incidence of diastolic dysfunction and increased repolarization dispersion.
- Diastolic dysfunction may be linked to electrical instability, as indicated by elevated QT dispersion in Behcet's disease.
Abstract:
Behcet's disease is a generalized chronic inflammatory disease characterized by genital, ocular, and cardiovascular involvement. Recently, left ventricular diastolic dysfunction, ventricular arrhythmia and sudden cardiac death have been documented in Behcet's disease. From January 1996 to May 1998, we investigated left ventricular systolic and diastolic function, valvular heart disease, ischemic heart disease and repolarization dispersion in 71 cases, 40 men and 31 women (mean age, 36.8+/-10.3 years) with Behcet's disease. All of the results were compared with the control group of 33 men and 22 women (mean age, 37.9+/-9.6 years). Exercise stress test or myocardial perfusion scintigraphy was performed for the documentation of ischemia. All the patients and the controls were recorded by M-mode, 2-D and Doppler echocardiography. Ventricular wall thickness, valvular apparatus, left ventricular systolic and diastolic parameters were evaluated. Repolarization dispersion parameters were calculated as the difference between maximal and minimal values of QT from 12-lead electrocardiogram recording at baseline, immediate and end of recovery from the exercise stress tests. The measured parameters were compared with the control group by using statistical methods. In the Behcet's group of 22 patients (31%) E/A ratio was <1. In the control group of five cases (10%) E/A ratio was <1 (P=0.003). In the Behcet's group isovolumic relaxation time (IRT) and mitral deceleration time (MDT) were longer than the control group (P=0.002, P=0.041, respectively). A mean QT of 368+/-30 ms and mean QT dispersion of 73+/-14 ms in the patient group compared with a mean QT of 395+/-39 ms and mean QT dispersion of 38+/-12 ms in the controls. There was no statistical difference between the mean QT values of the patient and control groups however, ventricular dispersion parameters in the Behcet's patients were longer than in the controls (P<0.001). There was also statistical significance for the QT dispersion between the Behcet's patients with and without diastolic dysfunction (P<0.01). In conclusion, the study reveals that the patients with Behcet's disease have a high incidence of increased diastolic dysfunction and repolarization dispersion. A positive correlation may exist between diastolic dysfunction and QT dispersion.