Reduced pressure wave reflections in patients with active clinical status of Adamantiades-Behcet disease

Acute and chronic inflammation has a deleterious effect on arterial structure and function. Increased arterial stiffness and pressure wave reflections may provide a pathophysiological link between inflammation and increased cardiovascular risk. Adamantiades-Behcet disease (ABD), a relapsing inflammatory vasculitis, is associated with impaired arterial properties modulated by corticosteroids. The effect of inflammation on arterial properties during the active state of ABD is not well known.

In 47 subjects with ABD, under no corticosteroid treatment, we examined pressure wave reflections (augmentation index, AIx) and central pressures by pulse wave analysis, as well as local aortic stiffness and left ventricular function by high resolution ultrasound. Thirty subjects with similar cardiovascular risk factors served as a control group.

Subjects with active ABD (n=11) had lower AIx and central systolic blood pressure (CSBP), but similar peripheral blood pressure, stroke volume, and slightly higher local aortic stiffness in comparison to patients with inactive ABD (n=36) (Alx: 12.6 +/- 11.4 vs. 23.2 +/- 19.1%, p=0.009; CSBP 104.2 +/- 12.4 vs. 115.4 +/- 15.7 mmHg, p=0.028). The arrival of the reflected pressure wave within the cardiac cycle was significantly delayed in subjects with active ABD. Low values of AIx (<10.5%) predicted with 73% sensitivity the presence of active ABD.

Patients with ABD, not treated with corticosteroids, have decreased pressure wave reflections and CSBP in the presence of active disease, possibly due to peripheral arterial vasodilation, but not due to altered left ventricular or aortic function. The underlying pathophysiological mechanisms and the role of low AIx in the presence of systemic inflammation need to be investigated further.