Silent but significant: subclinical cardiovascular changes in paediatric Behçet's disease

Behçet's disease (BD) is a systemic, autoinflammatory vasculitis with recurrent mucocutaneous ulcerations, ocular involvement, and multisystemic manifestations, including cardiovascular complications. While extensively studied in adults, paediatric BD, particularly regarding cardiovascular involvement, remains underexplored. This study assesses cardiovascular manifestations in paediatric BD through echocardiographic, vascular, and microvascular evaluations.

A total of 58 subjects were enrolled, including 29 paediatric BD patients and 29 healthy children. Exclusion criteria included comorbidities or prior cardiovascular diseases. Capillaroscopy assessed nailfold microvascular changes, and carotid artery intima-media thickness (CIMT) was measured via ultrasonography. Transthoracic echocardiography evaluated cardiac parameters, including ventricular function and indices of aortic stiffness and pulmonary vascular resistance.

The mean age of BD patients was 15.8 years, with disease onset at 12.4 years. Elevated left ventricular myocardial performance index (LV MPI), reduced right ventricular systolic function, and increased pulmonary arterial pressure. Aortic stiffness was also significantly higher, indicating early vascular remodelling. CIMT showed no significant differences. Mild capillary tortuosity was observed in some BD patients.

The findings suggest early cardiovascular changes in paediatric BD, including diastolic dysfunction, increased pulmonary arterial pressure, and impaired aortic elasticity. These results highlight the need for routine cardiovascular screening, even without overt cardiac symptoms, to mitigate long-term cardiovascular risks. Further studies are needed to understand these abnormalities' progression and optimise interventions.