Evaluation of the relationship between disease severity and echocardiographic parameters in Behçet's disease.

BACKGROUND: Behçet’s disease is a multisystemic inflammatory disorder that may affect the cardiovascular system through mechanisms such as vasculitis, endothelial dysfunction, and microvascular ischemia. Although cardiac involvement is often subclinical, early detection is important for prognosis. Global longitudinal strain (GLS) has emerged as a sensitive tool for identifying subtle myocardial dysfunction. This study aimed to compare conventional and strain-based echocardiographic parameters between patients with Behçet’s disease and healthy controls, and to investigate the relationship between disease activity and myocardial strain. METHODS: A total of 59 patients with Behçet’s disease and 58 age- and sex-matched healthy volunteers were included. Clinical activity was assessed using the Behçet’s Disease Current Activity Form (BDCAF). All participants underwent comprehensive transthoracic echocardiography, including tissue Doppler imaging and two-dimensional speckle-tracking analysis. Left ventricular (LV) and right ventricular (RV) GLS, MAPSE, TAPSE, MPI, diastolic parameters, and conventional chamber measurements were recorded. Correlation and multivariable linear regression analyses were performed to determine predictors of LV GLS. RESULTS: Patients with Behçet’s disease had significantly lower LV and RV GLS values compared with controls (LV GLS: −21.6 [IQR 18.4–24.5] vs. −21.7 [18.0–24.5], p = 0.001; RV GLS: −22.1 [19.0–27.2] vs. −22.8 [22.1–27.2], p = 0.001). MAPSE (1.7 [1.3–2.4] vs. 1.87 [1.2–3.0], p = 0.001), TAPSE (2.0 [1.3–2.9] vs. 2.16 [1.6–2.9], p = 0.001), and MPI (0.6 [0.3–1.0] vs. 0.7 [0.4–1.1], p = 0.049) were also significantly reduced in the Behçet group. Diastolic function parameters were impaired in the Behçet group, including a lower E/A ratio (1.0 [0.5–2.1] vs. 1.2 [0.7–1.8], p = 0.001) and prolonged isovolumic relaxation time (147.3 [74–289] ms vs. 117.2 [88–197] ms, p = 0.001). BDCAF scores showed a strong negative correlation with both LV GLS (r = − 0.56, p < 0.001) and RV GLS (r = − 0.64, p < 0.001). In multivariable linear regression analysis, the presence of Behçet’s disease (β = 0.618, p < 0.001), diabetes mellitus (β = −0.192, p = 0.009), and age (β = −0.228, p = 0.001) emerged as independent predictors of impaired LV GLS. CONCLUSION: Behçet’s disease is associated with subclinical impairment of both LV and RV function despite preserved ejection fraction. GLS strongly correlates with disease activity, suggesting that inflammatory burden contributes to early myocardial dysfunction. Incorporating strain analysis into routine cardiac evaluation may improve early detection and risk stratification in Behçet’s disease.