EVALUATION OF THE RELATIONSHIP BETWEEN PULMONARY ARTERY STIFFNESS AND RIGHT VENTRICULAR FUNCTION IN PATIENTS WITH BEHÇET’S DISEASE USING TRANSTHORACIC ECHOCARDIOGRAPHY
Authors: Yaşar Salim , Unlu Murat , gormel suat , Yalcinkaya Emre , BUGAN Baris , Gökoğlan Yalçın , Yıldırım Erkan , Fırtına Serdar , Asil Serkan , CELIK Murat , Yuksel Uygar , Kabul Hasan , Çınar Muhammet , barcin cem 
Published: November 2021

Background: Behçet’s disease is a systemic vasculitis that can
affect all sizes of arteries and veins. Arterial stiffness is a term
used to describe the visco-elastic properties of vessel wall. In this
study, we aimed to evaluate the relationship between pulmonary artery
stiffness (PAS) and the right ventricular (RV) functions in asymptomatic
Behçet’s patients with no cardiovascular risk factors. Methods:
We studied 40 patients who were diagnosed by the international
diagnostic criteria of Behçet’s disease and 40 healthy individuals who
were matching demographic properties with the patients. Two groups were
matched by age, gender, clinical history and other clinical features.
Substantial medical history concerning the factors that can affect right
ventricle diastolic function (such as medications, smoking status, other
comorbities, etc.) was taken and general physical examination was
carried out. The right and left ventricular functions as well as
valvular functions were evaluated by using echocardiography. Also
Two-dimensional, M-mode, pulsed wave (PW) Doppler echocardiographic
parameters were measured for right ventricular functions. PW Doppler
flow trace was obtained from the pulmonary valve with regards to
pulmonary artery stiffness. Results: There was no significant
difference in terms of clinical and demographic properties. No
statistically significant difference was found upon comparison of the
left ventricular end of systole and diastole diameters, the diastolic
and systolic thicknesses of the interventricular septum (IVS) and left
ventricular posterior wall (LVPW), left atrium (LA) diameter and left
ventricular ejection fraction (LVEF) values (p>0.05) of the
two groups. Right ventricular myocardial performance index (MPI) value
was found higher in Behçet’s patients and a statistically significant
difference was detected between the groups (p<0.01). Tricuspid
annular plane systolic excursion (TAPSE) values were found to be
statistically significantly lower in the patient group as compared to
the control group (p<0.01). In PW Doppler measurements, early
passive filling (E) wave flow velocity and E/A ratio were found to be
statistically significantly lower, deceleration time (DT) was higher in
the patient group (p<0.01). In Behçet’s patients without
clinical pulmonary involvement, the pulmonary artery systolic pressure
(PASP) was found to be statistically significantly higher in the patient
group (p<0.01). The values of pulmonary artery stiffness (PAS)
were found to be significantly higher in the patient group
(p<0.01). The relationship between the right ventricular
function markers and PAS were evaluated in the patient group. There was
no statistically significant relationship between PAS and MPI and TAPSE.
But there was a significant correlation between PAS and PASP and
duration of illness (p<0.001 and r=0.682 ; p=0.047 and
r=0,316). Conclusion: Behçet’s patients without cardiac
symptoms and signs, reduction in right ventricular functions and
increase in PAS was detected. Although there is no correlation between
right ventricular functions and PAS, increased PAS may be an early
marker of reduction of the right ventricular functions. Consequently,
routine cardiological examination and detailed evaluation of
biventricular functions by using echocardiography should be greatly
beneficial in Behcet’s patients, even though there are no signs or
symptoms.