Letter to the Editor
The increase in P-wave dispersion is associated with the duration of disease in patients with Behçet's disease

https://doi.org/10.1016/j.ijcard.2006.12.087Get rights and content

Abstract

Aim

P-wave dispersion (PD) has been reported to be associated with inhomogeneous and discontinuous propagation of sinus impulses. Behçet's disease (BD) is a chronic multi-system disease presenting with recurrent oral and genital ulceration, and relapsing uveitis. Left ventricular diastolic dysfunction, ventricular arrhythmia and sudden cardiac death have been documented in Behçet's disease. The aim of this study was to evaluate myocardial involvement noninvasively in patients with BD by measuring PD.

Methods

Study population included 29 patients with BD (group I), (16 males, mean age: 60.4 ± 10.1 years), and 45 normal (group II), (23 males, mean age: 61.2 ± 12.0 years). The maximum and minimum P-wave duration (Pmax and Pmin) and PD were measured from the 12-lead surface electrocardiogram. Echocardiographic examination was also performed.

Results

There was no statistically significant difference between two groups in respect to age, gender, hypertension, diabetes mellitus, hyperlipidemia and cigarette smoking (p > 0.05). Pmax and PD of patients with BD were found to be significantly higher than those of control subjects (116.2 ± 14.0 ms vs. 102.0 ± 16.5 and 49.3 ± 12.7 ms vs. 29.3 ± 8.5 ms, respectively p < 0.0001). Moreover, we found a significant positive correlation between PD with BD duration (r = 0.78, p < 0.0001).

Conclusion

Pmax and PD are found to be greater in patients with BD than in controls and are related with the duration of the disease.

Introduction

Behçet's disease is recognized as a multisystemic disorder which mainly affects young adults in Mediterranean, Middle Eastern and Far Eastern countries. Because there is no diagnostic laboratory test, the diagnosis is very difficult, characteristic clinical features, such as urogenital aphthae, ocular and skin lesions, arthritis, neurologic, gastrointestinal vascular and pulmonary involvements, may help to overcome this problem. Cardiovascular involvement of BD is reported as 7–29% [1]. Various cardiovascular manifestations such as coronary artery disease, conduction system disturbances, and valvular diseases have been reported, but are rare.

P-wave abnormalities, detected from the electrocardiogram (ECG), have been thought to reflect left atrial enlargement [2], left atrial hypertension [3] and altered conduction [4]. A simple ECG marker, P-wave dispersion (PD), has been used to evaluate the intraatrial and interatrial conduction times and the inhomogeneous propagation of sinus impulses which are well known electrophysiologic characteristics of the atrium prone to fibrillation [5], [6]. P-wave dispersion was defined as the difference between Pmax and Pmin [5]. Prolonged P-wave duration and PD have been reported to represent an increased risk for atrial fibrillation (AF) in patients with no underlying heart disease [5], [6]. Increased Pmax and PD are also related with stable angina pectoris [7], acute coronary syndromes [8], coronary slow flow phenomenon [9] and those undergoing coronary artery bypass surgery [10].

Although, there are few studies that demonstrated the electrical irregularity in patients with BD [10], to our knowledge, this is the first study evaluating PD in those patients. The aim of the investigation was to study whether there is an association between PD and BD compared to normal subjects.

Section snippets

Study population

The study population included 29 patients with BD (group I) (16 male, mean age: 60.4 ± 10.1 years) and age and sex-matched 45 normal subjects (group II) (23 male, mean age: 61.2 ± 12.0 years). Patients with positive stress test, left ventricular dysfunction, echocardiographically proven left ventricular hypertrophy, AF, bundle branch block, evidence of any other intraventricular conduction defect, or electrolyte abnormalities were excluded from the study. No subjects were under antiarrhythmic,

Results

Reproducibility was estimated by analyzing all recordings on 2 separate occasions (intraobserver variability); to assess interobserver variability, investigators were blinded. Intraobserver and interobserver coefficients of variation averaged 8% and 10%, respectively.

There were no statistically significant differences between the two groups with respect to age, gender, risk factors such as smoking, diabetes mellitus and hypertension (Table 1). Both Pmax and PD were higher in group I patients

Discussion

The main finding of the present study was that regardless of clinical significant cardiac involvement, Pmax and PD are both significantly higher in patients with BD than normal subjects. In the literature, it has been implicated that cardiac involvement appearing with symptoms of Behçet's disease is quite rare [11], [12], [13]; however, it is thought that heart disease due to Behçet's syndrome can be seen frequently without symptoms.

P-wave dispersion is related to the nonhomogenous and

Study limitations

There are some limitations of this study. First, the number of study subjects is not large. Second, all measurements were obtained in a blinded manual conventional manner. Although manual measurement of P-wave duration performed on standard paper-printed ECG is of limited accuracy, we have a good value of interobserver and intraobserver variabilities. Third, we excluded patients with coronary artery diseases by symptoms, physical examination, and stress electrocardiogram. Thus, it is possible

Conclusion

Our study showed that Pmax and PD are associated with Behçet's disease. Additionally, we found that Behçet's disease may increase PD and Pmax on the basis of a significant positive correlation between PD with the duration of the disease (r = 0.78, p < 0.0001). Finally, PD may be a marker of cardiac involvement in these patients.

References (19)

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