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Cardiac Function and Diastolic Dysfunction in Behcet's Disease: A Systematic Review and Meta-Analysis
Fawad Aslam1, Salman J Bandeali2, Cynthia Crowson3
1Division of Rheumatology, Mayo Clinic Health System, Eau Claire, WI 54703, USA.
Insights
Diastolic dysfunction (DD) is more common in Behcet
Area of Science:
- Cardiology
- Rheumatology
- Internal Medicine
Background:
- Cardiovascular involvement is a known complication of Behcet's disease (BD).
- The prevalence and characteristics of cardiac dysfunction, specifically diastolic dysfunction (DD), in BD remain unclear.
- Understanding cardiac involvement is crucial for managing Behcet's disease.
Purpose of the Study:
- To systematically review and meta-analyze existing literature.
- To determine if cardiac dysfunction, particularly DD, is more prevalent in patients with Behcet's disease compared to controls.
- To identify specific echocardiographic parameters indicative of cardiac dysfunction in BD.
Main Methods:
- Systematic review and meta-analysis of published studies.
- Inclusion of studies analyzing echocardiographic findings in Behcet's disease patients.
- Utilized a random-effects model to calculate effect sizes for echocardiographic parameters.
Main Results:
- Analysis included 22 studies with 1624 subjects.
- Behcet's disease patients showed significantly increased left atrial dimension, aortic diameter, and isovolumetric relaxation time.
- Patients with BD exhibited significantly reduced ejection fraction, prolonged mitral deceleration time, and a lower E/A ratio, indicating diastolic dysfunction.
Conclusions:
- Diastolic dysfunction is significantly increased in Behcet's disease patients.
- Elevated left atrial dimension and aortic diameter are observed in BD.
- Reduced ejection fraction in BD patients warrants further investigation.
Abstract:
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), lower E/A ratio (-0.24, p = 0.05), and increased isovolumetric relaxation time (7.29, p < 0.00001). Conclusion. DD is increased in patients with BD by the presence of several echocardiographic parameters favoring DD as compared to controls. The meta-analysis also identified that LA dimension is increased in BD patients. EF has also been found to be lower in BD patients. Aortic diameter was also increased in BD patients as compared to controls.
