SILENT-MYOCARDIAL-ISCHEMIA IN BEHCETS-DISEASE

Objective. Behcet's disease (BD) is a multisystemic disorder usually d escribed as a triple symptom complex consisting of aphthous stomatitis , genital ulcerations, and uveitis. Vasculitis is a key feature of the disease, which may lead to functional disturbances in highly vascular ized organs. However, cardiac involvement is seldom recognized. We inv estigated the prevalence of silent myocardial ischemia (SMI) in BD as the clinical presentation of microvascular disease. Methods. Ambulator y cardiac monitoring (Holter) was used in 36 patients with BD to detec t silent myocardial ischemia. (201)Thallium myocardial perfusion scint igraphy and radionuclide ventriculography were also performed. All pat ients fulfilled International Study Group for Behcet's Disease criteri a and 11 of them had major vascular involvement. The same method was a lso performed on 38 control subjects for comparison of SMI positivity in patients with BD. Results. Ambulatory cardiac monitoring was perfor med for 9.2 +/- 0.9 h, mean heart rate was 82 +/- 9 bpm, and no seriou s rhythm disturbance was recorded. SMI was described in 9 of 36 patien ts (25%) (median age 38 years, range 30-46) as ST segment depression o f 3.00 +/- 0.42 mm with a duration of 4.01 +/- 0.9 min. One SMI positi vity only was recorded in the control group in a 52-year-old man with a stenotic lesion in the left anterior descending coronary artery (p < 0.001). Eight of 9 patients with SMI showed a partially reversible myo cardial perfusion defect after exertion, and 7 demonstrated some degre e of left ventricular wall motion abnormality by radionuclide ventricu lography. Coronary angiography was normal in 7 of 9 patients with SMI. Additionally, 7 of 9 patients with SMI had major vascular involvement while only 4 of 27 without SMI had major vascular disease (p = 0.0022 ). Conclusion. SMI incidence is significantly higher in BD compared to the control group. Impaired endothelial cell function map be the unde rlying cause in the pathogenesis of BD or of its vascular complication s such as SMI.