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CLINICAL RESEARCH: AORTIC ELASTANCE

Aortic elastic properties and left ventricular diastolic function in patients with Adamantiades-Behcet's disease

Ignatios Ikonomidis, MD, FESC^*,*, John Lekakis, MD, FESC^*, Kimon Stamatelopoulos, MD^*, Nikolaos Markomihelakis, MD, Phaedon G. Kaklamanis, MD and Myron Mavrikakis, MD^*

^* Department of Clinical Therapeutics, University of Athens, Alexandra Hospital, Athens, Greece
Rheumatology, Athens Medical Center, Athens, Greece

Manuscript received July 19, 2003; revised manuscript received August 26, 2003, accepted October 6, 2003.

^* Reprint requests and correspondence: Dr. Ignatios Ikonomidis, University of Athens, Department of Clinical Therapeutics, Alexandra Hospital, Perikleous 19, Nea Chalkidona, Athens, 14343, Greece.
ignoik{at}otenet.gr

OBJECTIVES: We investigated whether Adamantiades-Behcet's disease (ABD) is related to impaired aortic (Ao) elastic properties and left ventricular (LV) function.

BACKGROUND: Adamantiades-Behcet's disease is an inflammatory disorder characterized by vasculitis leading to vascular complications and, rarely, myocarditis.

METHODS: We studied 82 patients with ABD (age: 40 ± 12 years) and 24 normal control subjects by echocardiography. Abdominal Ao diameter (mm/m²) and Ao elastic indexes—namely, Ao strain (%), distensibility (cm² x dyn^–1x 10^–6), stiffness index, and pressure strain modulus (Ep) (cm² x dyn^–1 x 10^–6)—were calculated from the echocardiographically derived thoracic Ao diameters (mm/m²), and the measurement of pulse pressure obtained by cuff sphygmomanometry. Isovolumic relaxation time (IVRT) (ms), deceleration time (DT) (ms), and flow propagation velocity (FPV) (cm/s) were measured by Doppler echocardiography to assess diastolic LV function. The duration of disease and presence of vascular complications were noted.

RESULTS: Patients versus control subjects had increased Ao diameters (p < 0.01), lower mean Ao strain and distensibility (4 vs. 9 and 1.4 vs. 3.4, respectively, p < 0.01), higher mean aortic stiffness index and Ep (15.6 vs. 6 and 1.17 vs. 0.44, respectively, p < 0.01), and impaired IVRT and FPV (p < 0.01). Aortic function indexes were related to the duration of disease (p < 0.01) and increased DT (p < 0.01). Deceleration time >190 ms predicted vascular complications with 80% sensitivity and 71% specificity (odds ratio 6.52 [confidence interval: 2.23 to 19.03]).

CONCLUSION: Aortic elastic properties and diastolic LV function are impaired in patients with ABD and are interrelated. The link between diastolic LV dysfunction and vascular complications suggests the presence of a common pathophysiologic pathway and provides a possible marker of risk for vascular disease.

Abbreviations and Acronyms   ABD = Adamantiades-Behcet's disease   Ao = aorta   AoD = aortic diastolic diameter   AoS = aortic systolic diameter   DT = deceleration time   Ep = pressure strain modulus   FPV = flow propagation velocity   ISG = International Study Group   IVRT = isovolumic relaxation time   IVS = interventricular septum   LV = left ventricle/left ventricular   PP = pulse pressure   PW = posterior wall

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