Echocardiographic Evaluation of Coronary Microvascular Dysfunction and Biventricular Mechanics in Behçet's Disease:...

Behçet's disease (BD) is a systemic vasculitis that can present with cardiac involvement. The aim of this study is to evaluate subclinical cardiac involvement in BD patients using left ventricular global longitudinal strain (GLS), right ventricular strain (RVGLS), and coronary sinus flow (CSF) measurements, and to investigate the relationship between echocardiographic findings and disease activity (BDCAF) and cumulative damage (BODI) scores.

This cross-sectional study included 48 BD patients and 35 healthy controls. All participants underwent transthoracic echocardiography (TTE); biventricular strain was measured to evaluate function, and coronary sinus parameters were measured to evaluate coronary flow. In the BD group, disease activity was evaluated using the BDCAF, and cumulative organ damage was evaluated using the BODI score.

Compared to the control group, GLS (absolute; 18.51 ± 2.02 vs. 19.53 ± 1.71, p = 0.018), right ventricular free wall strain (RVFWS; absolute) (25.35 ± 3.32 vs. 26.87 ± 3.01, p = 0.047), and CSF index (2.62 ± 0.99 vs. 3.58 ± 1.17 mL/min/g, p < 0.001) were found to be significantly lower in the BD group. The CSF index showed a positive correlation with both GLS (r = 0.31, p = 0.004) and RVFWS (r = 0.26, p = 0.021). In multivariable linear regression analysis, the CSF index and gender were identified as independent predictors of GLS. While the BODI score, indicating cumulative organ damage, showed a significant negative correlation with biventricular strain parameters (GLS long axis; GLS-L, RVGLS, RVFWS) (p < 0.05); no significant relationship was observed between the BDCAF score, which reflects acute disease activity, and echocardiographic parameters. Furthermore, the combined model using GLS and the CSF index exhibited a higher diagnostic performance in distinguishing BD patients compared to their individual use (AUC: 0.759, 80.9% sensitivity, 65.7% specificity).

In BD patients, the decrease in CSF, reflecting coronary microangiopathy, is independently associated with the deterioration in myocardial deformation. Our findings suggest that subclinical cardiac involvement may be linked to the chronic disease burden accumulated over the years, rather than transient acute inflammatory flares. The integrated assessment of CSF and GLS with TTE provides a valuable and non-invasive strategy for the early detection of high-risk patients.