Reduced pressure wave reflections in patients with active clinical status of Adamantiades-Behcet disease.
BACKGROUND
Acute and chronic inflammation has a deleterious effect on arterial structure and function. Increased arterial stiffness and pressure wave reflections may provide a pathophysiological link between inflammation and increased cardiovascular risk. Adamantiades-Behcet disease (ABD), a relapsing inflammatory vasculitis, is associated with impaired arterial properties modulated by corticosteroids. The effect of inflammation on arterial properties during the active state of ABD is not well known.


METHODS
In 47 subjects with ABD, under no corticosteroid treatment, we examined pressure wave reflections (augmentation index, AIx) and central pressures by pulse wave analysis, as well as local aortic stiffness and left ventricular function by high resolution ultrasound. Thirty subjects with similar cardiovascular risk factors served as a control group.


RESULTS
Subjects with active ABD (n=11) had lower AIx and central systolic blood pressure (CSBP), but similar peripheral blood pressure, stroke volume, and slightly higher local aortic stiffness in comparison to patients with inactive ABD (n=36) (Alx: 12.6 +/- 11.4 vs. 23.2 +/- 19.1%, p=0.009; CSBP 104.2 +/- 12.4 vs. 115.4 +/- 15.7 mmHg, p=0.028). The arrival of the reflected pressure wave within the cardiac cycle was significantly delayed in subjects with active ABD. Low values of AIx (<10.5%) predicted with 73% sensitivity the presence of active ABD.


CONCLUSIONS
Patients with ABD, not treated with corticosteroids, have decreased pressure wave reflections and CSBP in the presence of active disease, possibly due to peripheral arterial vasodilation, but not due to altered left ventricular or aortic function. The underlying pathophysiological mechanisms and the role of low AIx in the presence of systemic inflammation need to be investigated further.
Protogerou
Athanassios D
AD
Department of Clinical Therapeutics, Alexandra Hospital, Medical School National & Kapodistrian University of Athens, Athens, Greece. aprotog@med.uoa.gr
Achimastos
Apostolos
A
Vlachopoulos
Charalambos
C
Stamatelopoulos
Kimon S
KS
Papaioannou
Theodore G
TG
Papamichael
Christos M
CM
Aznaouridis
Konstantinos
K
Kaklamanis
Phedon
P
Mavrikakis
Myron
M
Stefanadis
Christodoulos
C
Lekakis
John P
JP
D000328:Adult; D001158:Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001528:Behcet Syndrome / Q000503:physiopathology*; D004548:Elasticity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D016277:Ventricular Function, Left