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Behçet Hastalarında Kardiyak Tutulum: Retrospektif Tek Merkez Deneyimi

Yıl 2024, Cilt: 46 Sayı: 2, 262 - 268, 18.03.2024
https://doi.org/10.20515/otd.1375694

Öz

Behçet hastalığının (BH) mukokutanöz tutulumu iyi bilinmektedir, ancak kardiyak tutulum nadirdir ve artmış morbidite ve mortalite ile ilişkilidir. Bu çalışmada, BH’nin kardiyak tutulumunun klinik özelliklerini ortaya koymayı amaçladık. 2000-2021 yılları arasında 800 BH tanılı hastayı kardiyak tutulum açısından retrospektif olarak taradık. Bu kriterleri karşılayan 14 hasta çalışmaya dahil edildi. Demografik bilgiler, klinik özellikler, tedavi yöntemleri ve prognoz değerlendirildi. Hastaların tamamı erkek ve sigara içiyordu. Kardiyak tutulum için ortalama yaş 32,5±7,8 yıl olarak saptandı. Hastaların üçte birinde hastalık tanısı konmadan önce kardiyak tutulum gelişmişti. Hastalar üç ana gruba ayrıldı: 8’i intrakardiyak tromboz (İKT), 2’si koroner arter anevrizması ve 4’ü miyokard infarktüsü (Mİ). İKT’nin çoğunluğu sağ ventrikülde idi (6/8). Mİ olgularının tümünde sol ana koroner arter tamamen tıkanmıştı. Hastaların %57’sinde derin ven trombozu vardı. Steroidler en sık tercih edilen ajandı. 9 hastada Siklofosfamid 4 hastada azatioprin ve interferon kullanılmıştı. 10 hastaya varfarin ve 4’üne antitrombotik ilaç verildiği görüldü. Mortalite izlenen iki olguda ölüm nedeni bilinmiyordu. Kardiyak tutulum nadir olsa da BH’nin ciddi bir tutulum tipidir. Çoğunlukla sağ kalp boşluklarında İKT ile karşımıza çıktığı gözlendi. Erkek cinsiyet ve sigara kullanımı bu popülasyondaki en önemli risk faktörü olarak bulunmuştur.

Kaynakça

  • 1. Yazici H, Seyahi E, Hatemi G, Yazici Y. Behçet syndrome: a contemporary view. Nature Reviews Rheumatology 2018; 14:107–119.
  • 2. Demirelli S, Degirmenci H, Inci S, Arisoy A. Cardiac manifestations in Behcet's disease. Intractable & Rare Diseases Research 2015; 4:70–75.
  • 3. Geri G, Wechsler B, Thi Huong D L, et al. Spectrum of cardiac lesions in Behçet disease: a series of 52 patients and review of the literature. Medicine 2012; 91:25–34.
  • 4. Kechida M, Salah S, Kahloun R, Klii R, Hammami S, Khochtali I. Cardiac and vascular complications of Behçet disease in the Tunisian context: clinical characteristics and predictive factors. Advances in Rheumatology (London, England) 2018; 58: 32.
  • 5. Hatemi G, Christensen R, Bang D, et al. 2018 update of the EULAR recommendations for the management of Behçet's syndrome. Annals of the Rheumatic Diseases 2018; 77:808–818.
  • 6. International Study Group for Behçet's Disease.Criteria for diagnosis of Behçet's disease. Lancet (London, England) 1990; 335:1078–1080.
  • 7. International Team for the Revision of the International Criteria for Behçet's Disease (ITR-ICBD). The International Criteria for Behçet's Disease (ICBD): a collaborative study of 27 countries on the sensitivity and specificity of the new criteria. Journal of the European Academy of Dermatology and Venereology : JEADV 2014; 28: 338–347.
  • 8. Lakhanpal S, Tani K, Lie J. T, Katoh K, Ishigatsubo Y, Ohokubo,T. Pathologic features of Behçet's syndrome: a review of Japanese autopsy registry data. Human Pathology 1985;16: 790–795.
  • 9. Mogulkoc N, Burgess M. I, Bishop P. W. Intracardiac thrombus in Behçet's disease: a systematic review. Chest 2000; 118: 479–487.
  • 10. Yıldırım R, Oğuzman S, Dinler M, Bilge NŞY, Kaşifoğlu T. Scoping beyond pulmonary artery involvement; pulmonary involvement in Behcet's disease; a retrospective analysis of 28 patients. Clin Rheumatol 2023; 42:849-853
  • 11. Bletry O, Mohattane A, Wechsler B, et al. Atteinte cardiaque de la maladie de Behçet. Douze observations [Cardiac involvement in Behçet's disease. 12 cases]. Presse Medicale (Paris, France : 1983), 1988;17: 2388–2391.
  • 12. Gürgün C, Ercan E, Ceyhan C, et al.Cardiovascular involvement in Behçet's disease. Japanese Heart Journal 2002; 43: 389–398.
  • 13. Emmungil H, Yaşar Bilge NŞ, Küçükşahin O, et al. A rare but serious manifestation of Behçet's disease: intracardiac thrombus in 22 patients. Clinical and Experimental Rheumatology 2014;32: S87–S92.
  • 14. Aksu T, Tufekcioglu O. Intracardiac thrombus in Behçet's disease: four new cases and a comprehensive literature review. Rheumatology International 2015; 35: 1269–1279.
  • 15. Seyahi E, Melikoglu M, Akman C, et al. Pulmonary artery involvement and associated lung disease in Behçet disease: a series of 47 patients. Medicine 2012; 91:35–48.
  • 16. Erbilen E, Albayrak S, Gulcan E, et al. Acute coronary stenosis in a young man with Behçet's syndrome. Medical principles and practice : international journal of the Kuwait University, Health Science Centre 2008; 17: 157–160.
  • 17. Calgüneri M, Aydemir K, Oztürk M A, Haznedaroğlu IC, Kiraz S, Ertenli I. Myocardial infarction and deep venous thrombosis in a young patient with Behçet disease. Clinical and applied thrombosis/hemostasis: official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis 2006; 12: 105–109.
  • 18. Güllü I H, Benekli M, Müderrisoğlu H, et al. Silent myocardial ischemia in Behçet's disease. The Journal of Rheumatology 1996;23: 323–327.
  • 19. Chen H, Zhang Y, Li C, et al. Coronary involvement in patients with Behçet's disease. Clinical Rheumatology 2019; 38:2835–2841.
  • 20. Ahn JK, Lee YS, Jeon CH, Koh EM, Cha HS. Treatment of venous thrombosis associated with Behcet's disease: immunosuppressive therapy alone versus immunosuppressive therapy plus anticoagulation. Clinical Rheumatology 2008;27: 201–205.
  • 21. Desbois AC, Wechsler B, Resche-Rigon M, et al. Immunosuppressants reduce venous thrombosis relapse in Behçet's disease. Arthritis and Rheumatism 2012; 64:2753–2760.
  • 22. Assar S, Sadeghi B, Davatchi F, et al. The association of pathergy reaction and active clinical presentations of Behçet's disease. Reumatologia. 2017;55:79-83..
  • 23. Gheita TA, El-Latif EA, El-Gazzar II, et al. Egyptian College of Rheumatology-Behçet’s Disease Study Group (ECR-BDSG). Behçet's disease in Egypt: a multicenter nationwide study on 1526 adult patients and review of the literature. Clin Rheumatol. 2019 ;38:2565-2575.

Cardiac Involvement In Patients With Behcet’s Disease: A Retrospective, Single-Center Experience

Yıl 2024, Cilt: 46 Sayı: 2, 262 - 268, 18.03.2024
https://doi.org/10.20515/otd.1375694

Öz

Behcet’s disease (BD) is well-known with mucocutaneous involvement, whereas the heart may rarely be involved, predicting morbidity and mortality. In this study, we aimed to reveal the clinical characteristics of cardiac involvement in BD. We retrospectively screened 800 BD patients diagnosed between 2000 and 2021 for cardiac involvement. 14 patients who met these criteria were recruited in this study. Demographic information, clinical features, treatment modalities, and prognosis were evaluated. All patients were male and smokers. The mean age for cardiac involvement was estimated at 32.5 ±7,8 years. Cardiac involvement developed in one-third of the patients before disease diagnosis. Patients were classified into three major groups: 8 of intracardiac thrombosis (ICT), 2 of coronary artery aneurysms, and 4 of myocardial infarction (MI). The majority of ICT was seen in the right ventricle (6 out of 8). In all MI cases, the left main coronary artery was totally occluded. Deep vein thrombosis was seen in 57% of patients. Apart from steroids, cyclophosphamide was the most common preferred agent, used in 9 patients. Azathioprine and interferon use were seen in 4 cases. Warfarin was used in 10 patients and 4 cases received an antithrombotic agent. Mortality was seen in 2 cases due to unknown causes. Cardiac involvement is rare, but a serious manifestation of BD. ICT was the most common type with mostly involved the right heart chambers. Male gender and smoking were found as the most important associated risk factors in this population.

Kaynakça

  • 1. Yazici H, Seyahi E, Hatemi G, Yazici Y. Behçet syndrome: a contemporary view. Nature Reviews Rheumatology 2018; 14:107–119.
  • 2. Demirelli S, Degirmenci H, Inci S, Arisoy A. Cardiac manifestations in Behcet's disease. Intractable & Rare Diseases Research 2015; 4:70–75.
  • 3. Geri G, Wechsler B, Thi Huong D L, et al. Spectrum of cardiac lesions in Behçet disease: a series of 52 patients and review of the literature. Medicine 2012; 91:25–34.
  • 4. Kechida M, Salah S, Kahloun R, Klii R, Hammami S, Khochtali I. Cardiac and vascular complications of Behçet disease in the Tunisian context: clinical characteristics and predictive factors. Advances in Rheumatology (London, England) 2018; 58: 32.
  • 5. Hatemi G, Christensen R, Bang D, et al. 2018 update of the EULAR recommendations for the management of Behçet's syndrome. Annals of the Rheumatic Diseases 2018; 77:808–818.
  • 6. International Study Group for Behçet's Disease.Criteria for diagnosis of Behçet's disease. Lancet (London, England) 1990; 335:1078–1080.
  • 7. International Team for the Revision of the International Criteria for Behçet's Disease (ITR-ICBD). The International Criteria for Behçet's Disease (ICBD): a collaborative study of 27 countries on the sensitivity and specificity of the new criteria. Journal of the European Academy of Dermatology and Venereology : JEADV 2014; 28: 338–347.
  • 8. Lakhanpal S, Tani K, Lie J. T, Katoh K, Ishigatsubo Y, Ohokubo,T. Pathologic features of Behçet's syndrome: a review of Japanese autopsy registry data. Human Pathology 1985;16: 790–795.
  • 9. Mogulkoc N, Burgess M. I, Bishop P. W. Intracardiac thrombus in Behçet's disease: a systematic review. Chest 2000; 118: 479–487.
  • 10. Yıldırım R, Oğuzman S, Dinler M, Bilge NŞY, Kaşifoğlu T. Scoping beyond pulmonary artery involvement; pulmonary involvement in Behcet's disease; a retrospective analysis of 28 patients. Clin Rheumatol 2023; 42:849-853
  • 11. Bletry O, Mohattane A, Wechsler B, et al. Atteinte cardiaque de la maladie de Behçet. Douze observations [Cardiac involvement in Behçet's disease. 12 cases]. Presse Medicale (Paris, France : 1983), 1988;17: 2388–2391.
  • 12. Gürgün C, Ercan E, Ceyhan C, et al.Cardiovascular involvement in Behçet's disease. Japanese Heart Journal 2002; 43: 389–398.
  • 13. Emmungil H, Yaşar Bilge NŞ, Küçükşahin O, et al. A rare but serious manifestation of Behçet's disease: intracardiac thrombus in 22 patients. Clinical and Experimental Rheumatology 2014;32: S87–S92.
  • 14. Aksu T, Tufekcioglu O. Intracardiac thrombus in Behçet's disease: four new cases and a comprehensive literature review. Rheumatology International 2015; 35: 1269–1279.
  • 15. Seyahi E, Melikoglu M, Akman C, et al. Pulmonary artery involvement and associated lung disease in Behçet disease: a series of 47 patients. Medicine 2012; 91:35–48.
  • 16. Erbilen E, Albayrak S, Gulcan E, et al. Acute coronary stenosis in a young man with Behçet's syndrome. Medical principles and practice : international journal of the Kuwait University, Health Science Centre 2008; 17: 157–160.
  • 17. Calgüneri M, Aydemir K, Oztürk M A, Haznedaroğlu IC, Kiraz S, Ertenli I. Myocardial infarction and deep venous thrombosis in a young patient with Behçet disease. Clinical and applied thrombosis/hemostasis: official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis 2006; 12: 105–109.
  • 18. Güllü I H, Benekli M, Müderrisoğlu H, et al. Silent myocardial ischemia in Behçet's disease. The Journal of Rheumatology 1996;23: 323–327.
  • 19. Chen H, Zhang Y, Li C, et al. Coronary involvement in patients with Behçet's disease. Clinical Rheumatology 2019; 38:2835–2841.
  • 20. Ahn JK, Lee YS, Jeon CH, Koh EM, Cha HS. Treatment of venous thrombosis associated with Behcet's disease: immunosuppressive therapy alone versus immunosuppressive therapy plus anticoagulation. Clinical Rheumatology 2008;27: 201–205.
  • 21. Desbois AC, Wechsler B, Resche-Rigon M, et al. Immunosuppressants reduce venous thrombosis relapse in Behçet's disease. Arthritis and Rheumatism 2012; 64:2753–2760.
  • 22. Assar S, Sadeghi B, Davatchi F, et al. The association of pathergy reaction and active clinical presentations of Behçet's disease. Reumatologia. 2017;55:79-83..
  • 23. Gheita TA, El-Latif EA, El-Gazzar II, et al. Egyptian College of Rheumatology-Behçet’s Disease Study Group (ECR-BDSG). Behçet's disease in Egypt: a multicenter nationwide study on 1526 adult patients and review of the literature. Clin Rheumatol. 2019 ;38:2565-2575.
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Romatoloji ve Artrit
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Mustafa Dinler 0000-0002-8133-8278

Nazife Şule Yaşar Bilge 0000-0002-0783-1072

Reşit Yıldırım 0000-0003-4040-0212

Muzaffer Bilgin 0000-0002-6072-6466

Timuçin Kaşifoğlu 0000-0003-2544-8648

Yayımlanma Tarihi 18 Mart 2024
Gönderilme Tarihi 13 Ekim 2023
Kabul Tarihi 21 Şubat 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 46 Sayı: 2

Kaynak Göster

Vancouver Dinler M, Yaşar Bilge NŞ, Yıldırım R, Bilgin M, Kaşifoğlu T. Cardiac Involvement In Patients With Behcet’s Disease: A Retrospective, Single-Center Experience. Osmangazi Tıp Dergisi. 2024;46(2):262-8.


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