Cardiac magnetic resonance imaging in patients with Behçet’s disease

Ahmed, Ali A.; Tharwat, Samar; Batouty, Nihal M.; Bahy, Ahmed El; Tawfik, Ahmed M.; Shahin, Dina A.

doi:10.1186/s42358-021-00230-3

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Research • Adv. rheumatol. 61 • 2021 • https://doi.org/10.1186/s42358-021-00230-3 copy

Cardiac magnetic resonance imaging in patients with Behçet’s disease

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Behçet’s disease (BD) is a multisystemic vasculitis that may affect the heart. However, the incidence and nature of cardiac involvement in BD have not been clearly documented yet. The aim of this study was to delineate the cardiac magnetic resonance imaging (MRI) appearances of cardiac involvement in BD patients.

Methods:

This cross-sectional observational study was carried out 30 BD patients without known cardiac disease. Patients were subjected to history taking, physical examination, echocardiography and cardiac MRI.

Results:

At least one abnormality on cardiac MRI was observed in 20/30 patients (66.67%). Myocardial oedema was observed in 3 patients (10%) and late gadolinium enhancement in 1 patient (3.3%). Pericardial effusion was found in 3 patients (10.0%), global hypokinesia in 6 patients (20.0%) and intra-cardiac thrombosis in only 1 patient (3.3%). Pulmonary artery was dilated in 4 patients (13.3%). Left ventricular (LV) and right ventricular (RV) end diastolic volume were altered in 4 patients (13.3%) and 7 patients (23.3%) respectively. LV and RV end systolic volume were abnormal in 7 patients (23.3%) and 5 patients (16.7%) respectively. There was aortic valve regurge in 2 patients (6.7%), tricuspid valve regurge in 9 patients (30%), and mitral valve regurge in 9 patients (30%). Dilated left main coronary artery was found in 2 patients (6.7%) and arrhythmogenic right ventricular dysplasia in only one patient 1 patient (3.3%). On logistic regression analysis, BD activity index score was a significant predictor of cardiac abnormalities.

Conclusion:

BD may cause cardiac abnormalities without clinical manifestations and cardiac MRI may represent a tool for early detection of these subtle abnormalities. Higher BD activity index scores are strongly linked to cardiac problems.

Keywords:
Behçet’s disease; Heart; Cardiac MRI

Characteristic		Value
Demographic and clinical characteristics
Age (years), M ± SD		32.3 ± 8.9
Sex
	Male, n (%)	21 (70)
	Female, n (%)	9 (30)
Behçet’s disease duration (years), median (min-max)		3 (1.5-7)
Height (cm), M ± SD		171.03 ± 5.49
Weight (kg), M ± SD		75.37 ± 9.22
BMI (kg/m²), M ± SD		25.82 ± 3.37
Heart rate (bpm), M ± SD		89.50 ± 7.69
SBP (mmHg), M ± SD		127.5 ± 6.53
DBP (mmHg), M ± SD		78.33 ± 9.49
Behcet disease activity index score, M ± SD		4.60 ± 1.4
	≤ 4, n (%)	15 (50)
	> 4, n (%)	15 (50)
Cumulative manifestations of Behcet disease, n (%)
	Orogenital Ulcers	30 (100)
	Uveitis	23 (76.7)
	Cutaneous manifestations	11 (36.7)
	Musculoskeletal manifestations	10 (33.3)
	Gastrointestinal tract manifestations	1 (3.3)
	Deep venous thrombosis	4 (13.3)
Laboratory characteristics
Complete blood count
	Hb (g/dL), M ± SD	11.83 ± 1.01
	WBCs (10³ /mm³), M ± SD	4.63 ± 1.5
	PLT (10³ /mm³), M ± SD	222.8 ± 53.6
Serum creatinine (mg/dL), M ± SD		0.91 ± 0.11
Erythrocyte sedimentation rate (mm/hr), M ± SD		35.33 ± 10.08
Positive C-reactive protein, n (%)		14 (46.7)
Echocardiographic findings
	Ejection fraction (%), M ± SD	59.73 ± 5.09
	Pericardial effusion, n (%)	2 (6.7)
	Global hypokinesia, n (%)	6 (20)
	Aortic valve regurge, n (%)	1 (3.3)
	Tricuspid valve regurge, n (%)	8 (26.7)
	Intra-cardiac thrombosis, n (%)	1 (3.3)
Medications used for treatment, n (%)
	Colchicine	30 (100)
	Steroids	30 (100)
	Azathioprine	14 (46.7)
	Cyclosporine	14 (46.7)
	Anticoagulants	5 (16.7)
	Biological agents	10 (33.3)
Dose of steroids (mg /day), median (min-max)		20 (0-60)

Findings of cardiac MRI		The study patients (n = 30)
End diastolic volume (ml), M ± SD
	Left ventricle	79.36 ± 19.71
	Right ventricle	85.46 ± 23.09
End systolic volume (ml), M ± SD
	Left ventricle	31.59 ± 9.59
	Right ventricle	40.84 ± 12.15
Stroke volume (ml), M ± SD
	Left ventricle	46.74 ± 12.29
	Right ventricle	46.27 ± 11.53
Ejection fraction (%), M ± SD
	Left ventricle	60.20 ± 5.81
	Right ventricle	53.70 ± 4.74
End diastolic wall mass (g/m²), M ± SD		61.46 ± 11.2
Signs of myocarditis, n (%)
	Myocardial edema	3 (10)
	Late gadolinium enhancement	1 (3.3)
Cardiac valves, n (%)
	Aortic valve regurge	2 (6.7)
	Pulmonary valve regurge	0
	Tricuspid valve regurge	9 (30)
	Mitral valve regurge	9 (30)
Blood vessels
	Mid ascending aorta diameter (mm), M ± SD	28.18 ± 3.07
	Aortic sinus root diameter (mm), M ± SD	29.98 ± 2.76
	Main pulmonary artery diameter (mm), M ± SD	23.74 ± 3.45
	Pulmonary /aortic ratio, M ± SD	0.80 ± 0.16
	Right pulmonary artery diameter (mm), M ± SD	16.09 ± 2.24
	Left pulmonary artery diameter (mm), M ± SD	16.71 ± 2.38
	Increased Pulmonary /aortic ratio, n (%)	3 (10)
	Dilated main pulmonary artery, n (%)	4 (13.3)
	Bilateral pulmonary artery aneurysm and embolism, n (%)	1 (3.3)
	Dilated left main coronary artery (coronary aneurysm), n (%)	2 (6.7)
	SVC thrombosis	1 (3.3)
Other findings, n (%)
	Pericardial effusion	3 (10)
	Global hypokinesia	6 (20)
	Arrythmogenic right ventricular dysplasia ^* * Major criterion of ARVD by MRI; dyskinesia of right ventricular free wall with right ventricular end diastolic volume indexed to body surface area more than 110 ml/m2	1 (3.3)
	Right ventricular thrombus	1 (3.3)

Variables		With normal cardiac MRI )n = 5( (% = 16.67)	With abnormal cardiac MRI (n = 25( (% = 83.33)	P value
Demographic and clinical characteristics
Age (years), M ± SD		26.0 ± 2.65	33.56 ± 9.22	.084
Sex
	Male, n (%)	2 (40)	19 (76)	.109
	Female, n (%)	3 (60)	6 (24)
Behçet’s disease duration (years), median (min-max)		2 (2-3)	3 (1-7)	.176
Height (cm), M ± SD		171.6 ± 4.77	170.92 ± 5.71	.723
Weight (kg), M ± SD		74 ± 8.22	75.64 ± 9.54	.723
BMI (kg/m²), M ± SD		25.08 ± 1.86	25.96 ± 3.6	.60
Heart rate (bpm), M ± SD		88 ± 4.47	89.9 ± 8.23	.641
SBP (mmHg), M ± SD		124 ± 5.47	128.2 ± 6.59	.19
DBP (mmHg), M ± SD		70 ± 7.07	80 ± 9.13	.806
Behcet disease activity index score, M ± SD
	≤ 4, n (%)	1(20)	14(56)	.33
	> 4, n (%)	4(80)	11(44)
Cumulative manifestations of Behcet disease
	Orogenital Ulcers	5(100)	25(100)	1
	Uveitis	4(80.0)	19(76.0)	1
	Cutaneous manifestations	1(20.0)	10(40.0)	.63
	Musculoskeletal manifestations	2 (40)	8 (32)	1
	Gastrointestinal tract manifestations	1 (20)	1(4)	1
	Deep venous thrombosis	1(20)	3 (12)	.53
Laboratory characteristics
Complete blood count
	Hb (g/dL), M ± SD	11.90 ± 0.74	11.82 ± 1.07	.88
	WBCs (10³ /mm³), M ± SD	4.26 ± 0.78	4.71 ± 0.71	.21
	PLT (10³ /mm³), M ± SD	225.0 ± 32.02	222.36 ± 57.48	.92
Serum creatinine (mg/dL), M ± SD		0.86 ± 0.09	0.916 ± 0.11	.312
Erythrocyte sedimentation rate (mm/hr), M ± SD		33.0 ± 12.04	33.0 ± 12.04	.58
Positive C-reactive protein, n (%)		2(40)	12(48)	1
Medications used for treatment, n (%)
	Colchicine	5 (100)	25 (100)	1
	Steroids	5 (100)	25 (100)	1
	Azathioprine	4 (80)	10 (40)	.157
	Cyclosporine	1 (20)	11 (44)	.62
	Anticoagulants	1 (20)	4 (16)	1
	Biological agents	1 (20)	9 (36)	.64

Variable	Odds ratio (95% CI)	95% CI		P value
Variable	Odds ratio (95% CI)	LL	UL	P value
Age/years	1.25	0.97	1.59	.08
Sex (male)	4.75	0.64	35.48	.13
Behcet disease duration	1.88	0.72	4.96	.19
Heart rate	1.04	0.85	1.27	.74
SBP	1.32	0.98	1.79	.07
DBP	1.28	1.03	1.59	.03 ^* * P ≤ 0.05
BMI	1.26	0.83	1.92	.28
Behcet’s disease activity index	0.42	0.18	1.0	.05 ^* * P ≤ 0.05
Azathioprine	0.17	0.007	4.03	.270
Cyclosporine	0.79	0.02	33.18	.902
Anticoagulants	0.81	0.03	23.56	.904
Biological agents	1.44	0.03	66.77	.853

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[1] * Correspondence: samartharwat2000@yahoo.com