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Qian YL, Quan RL, Chen XX, Lin YY, Jing XL, Gu Q, Xiong CM, He JG, Zhi AH. Imaging characteristics and prognostic factors of Behcet's disease with arterial involvement: A long-term follow-up study. Eur J Radiol 2024; 170:111206. [PMID: 37995514 DOI: 10.1016/j.ejrad.2023.111206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/22/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE To investigate the imaging characteristics and prognostic factors for the long-term survival of Behcet's disease (BD) with arterial involvement. METHODS In this retrospective study, BD patients with arterial involvement were identified from January 2003 to January 2020. Arterial lesions were detected by ultrasonography, traditional arteriography, and/or computed tomography angiography (CTA). Cox proportional hazards regression analyses were performed to identify the prognostic factors. RESULTS Totally, 84 BD patients with arterial involvement were identified (73.8 % males). The mean age at BD diagnosis was 39.1 ± 13.1 years. Arterial involvement was the initial manifestation in 33.3 % of the patients, and the median time from BD diagnosis to arterial involvement was 6 (IQR 1-15.5) years for the rest of patients. Systemic artery involvement and pulmonary artery involvement (PAI) were found in 64 and 27 patients, respectively. Approximately 94.0 % (79/84) of the patients had more than one artery involved concurrently or successively during the course of BD. Aneurysm/dilation was the most prevalent lesion in the aorta (76.0 %), while stenosis/occlusion was the main lesion of the coronary artery (90.9 %) and other aortic branches (74.5 %). Pulmonary hypertension was found in 70.4 % (19/27) of patients with PAI. The 5- and 10-year survival rates of BD patients with arterial involvement were 87.4 % and 84.1 %, respectively. Cardiac involvement (HR: 4.34) and pulmonary artery aneurysm/dilation (HR: 4.89) were independently associated with mortality. CONCLUSIONS Arterial lesions associated with BD usually involve multiple arteries and manifest differently in different types of arteries. Cardiac involvement and pulmonary artery aneurysm/dilation are independent prognostic factors of BD patients with arterial involvement.
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Affiliation(s)
- Yu-Ling Qian
- Department of Pulmonary Vascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, 100037 Beijing, China
| | - Rui-Lin Quan
- Department of Pulmonary Vascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, 100037 Beijing, China
| | - Xiao-Xi Chen
- Department of Pulmonary Vascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, 100037 Beijing, China
| | - Yang-Yi Lin
- Department of Pulmonary Vascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, 100037 Beijing, China
| | - Xiao-Li Jing
- Department of Pulmonary Vascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, 100037 Beijing, China
| | - Qing Gu
- Department of Pulmonary Vascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, 100037 Beijing, China
| | - Chang-Ming Xiong
- Department of Pulmonary Vascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, 100037 Beijing, China
| | - Jian-Guo He
- Department of Pulmonary Vascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, 100037 Beijing, China
| | - Ai-Hua Zhi
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China; Department of Radiology, Yunnan Fuwai Cardiovascular Hospital, 650000 Kunming, China.
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Kariyanna PT, Shah P, Jayarangaiah A, Chowdhury YS, Lazaro D. Acute coronary syndrome in Behcet's syndrome: A systematic review. Eur J Rheumatol 2020; 8:31-35. [PMID: 32910756 DOI: 10.5152/eurjrheum.2020.19213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 06/28/2020] [Indexed: 01/29/2023] Open
Abstract
Behcet syndrome is a rare vasculitis that affects both arteries and veins. Vasculo-Bechet Syndrome (VBS) is seen predominantly in men. Genetic predisposition and immune dysregulation leading to inflammation, endothelial damage, and impaired fibrinolysis contribute to its pathogenesis. Isolated case reports of Behcet syndrome (BS) with associated acute coronary syndrome (ACS) have been reported in the past. In this study, we present the first systematic review of such cases. A systematic search was conducted using Pubmed, Google Scholar, CINAHL, Cochrane CENTRAL, and Web of Science databases from 1980-2018 to identify case reports of myocardial infarction associated with BS. Cases that fulfilled the criteria for BS were selected for analysis. Demographic data, electrocardiography, echocardiography, angiography findings, and management were analyzed when available. We identified 62 case reports. Most subjects were men with a mean age of 37 years. Twenty-one percent were smokers, but other traditional cardiovascular risk factors were less common. Myocardial infarction was confirmed in half of the cases with findings on electrocardiogram (ECG). Echocardiogram revealed wall motion abnormality in 76% of patients, and angiography showed double-vessel disease in more than half of the cases. Mortality was reported in 1.6% of the cases. This systematic review shows that ACS in BS affects young males with low prevalence of coronary artery disease risk factors. Chest pain is the most common presenting feature and ST-segment elevation myocardial infarction (STEMI) was the most common ECG finding. Immunotherapy may be helpful to prevent future ACS in these patients.
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Affiliation(s)
- Pramod Theetha Kariyanna
- Division of Cardiovascular Disease, Department of Internal Medicine, State University of New York-Downstate Medical Center, Brooklyn, New York, USA
| | - Parth Shah
- New York Institute of Technology College of Osteopathic Medicine, Glen Head, New York, USA
| | - Apoorva Jayarangaiah
- Department of Internal Medicine, Wake Forest University-Baptist Health, Winston-Salem, North Carolina, USA
| | - Yuvraj Singh Chowdhury
- Division of Cardiovascular Disease, Department of Internal Medicine, State University of New York-Downstate Medical Center, Brooklyn, New York, USA
| | - Deana Lazaro
- Division of Rheumatology, Department of Internal Medicine, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York, USA
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Abstract
Behçet’s disease (BD) is a systemic vasculitis of unknown etiology. It is characterized by recurrent oral and genital ulcers, uveitis, and a number of systemic manifestations. Although the disease is recognized worldwide, its prevalence is highly variable. A detailed review and analysis of the worldwide published reports on BD showed that not only the prevalence of the disease but also its cardiac complications differ according to the geographic distribution of the studied population. With the exception of France, Greece, Spain, and Italy, very few reports and studies regarding BD have been published from the western countries. Cardiovascular complications are an important cause of poor outcome in patients with BD. Over the past few years, many case reports and studies have been published, providing more facts about these complications. For example, peculiar echocardiographic findings in patients with aortic valve regurgitation and intracardiac thrombi secondary to BD were recently described. The role of these findings in the initial diagnosis of the disease, however, remains to be evaluated. On the other hand, some reports present contradictory results, especially concerning the left ventricular diastolic function, pathogenesis of coronary artery disease, and proper management of the cardiac complications in BD. Importantly, management of these complications is based mainly on the discretion of the treating physician due to the absence of large controlled studies and clear guidelines. This approach sometimes creates inconsistent data and allows controversies to persist. The review presented here will discuss some of the facts and controversies related to cardiac complications in BD.
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4
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Jeon CH, Kim YK, Chun EJ, Kim JA, Yong HS, Doo KW, Choi SI. Coronary artery vasculitis: assessment with cardiac multi-detector computed tomography. Int J Cardiovasc Imaging 2015; 31 Suppl 1:59-67. [DOI: 10.1007/s10554-015-0652-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
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Shah AH, Goodfellow R, Kinnaird T, Mitra R. Inappropriate vascular response in patients with Behçet syndrome. Circ Cardiovasc Interv 2014; 7:726-7. [PMID: 25336607 DOI: 10.1161/circinterventions.114.001658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ashish H Shah
- From the Cardiology Department, Toronto General Hospital, Toronto, ON, Canada (A.H.S.); Department of Rheumatology (R.G.) and Cardiology Department (R.M.), Royal Glamorgan Hospital, Llantrisant, United Kingdom; and Cardiology Department, University Hospital of Wales, Cardiff, United Kingdom (T.K.).
| | - Rhian Goodfellow
- From the Cardiology Department, Toronto General Hospital, Toronto, ON, Canada (A.H.S.); Department of Rheumatology (R.G.) and Cardiology Department (R.M.), Royal Glamorgan Hospital, Llantrisant, United Kingdom; and Cardiology Department, University Hospital of Wales, Cardiff, United Kingdom (T.K.)
| | - Timothy Kinnaird
- From the Cardiology Department, Toronto General Hospital, Toronto, ON, Canada (A.H.S.); Department of Rheumatology (R.G.) and Cardiology Department (R.M.), Royal Glamorgan Hospital, Llantrisant, United Kingdom; and Cardiology Department, University Hospital of Wales, Cardiff, United Kingdom (T.K.)
| | - Rito Mitra
- From the Cardiology Department, Toronto General Hospital, Toronto, ON, Canada (A.H.S.); Department of Rheumatology (R.G.) and Cardiology Department (R.M.), Royal Glamorgan Hospital, Llantrisant, United Kingdom; and Cardiology Department, University Hospital of Wales, Cardiff, United Kingdom (T.K.)
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Şahin DY, Elbasan Z, Gür M, Huseinov M, Çaylı M. Successful treatment for a giant coronary saccular aneurysm complicated with myocardial infarction in a patient with Behcet's disease: Case report. J Cardiol Cases 2012; 6:e118-e120. [PMID: 31391871 PMCID: PMC6436560 DOI: 10.1016/j.jccase.2012.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 06/12/2012] [Accepted: 07/12/2012] [Indexed: 12/13/2022] Open
Abstract
We report on a 35-year-old man, with known Behcet's disease, who was admitted with the diagnosis of subacute anterior myocardial infarction. Coronary angiography revealed an isolated giant saccular aneurysm at the mid segment of left anterior descending coronary artery with a tight stenosis. The patient was successfully treated with covered stent on the first day of admission.
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Affiliation(s)
- Durmuş Yıldıray Şahin
- Department of Cardiology, Adana Numune Education and Research Hospital, Adana 01150, Turkey,Corresponding author. Tel.: +90 322 335 03 03; fax: +90 322 335 03 15.
| | - Zafer Elbasan
- Department of Cardiology, Adana Numune Education and Research Hospital, Adana 01150, Turkey
| | - Mustafa Gür
- Department of Cardiology, Adana Numune Education and Research Hospital, Adana 01150, Turkey
| | - Mehman Huseinov
- Department of Cardiology, Acıbadem Adana Hospital, Acıbadem University, Adana, Turkey
| | - Murat Çaylı
- Department of Cardiology, Adana Numune Education and Research Hospital, Adana 01150, Turkey
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Greenhouse DG, Hackett K, Kahn P, Balsam LB, Galloway AC. Giant coronary artery aneurysm in a patient with Behçet's disease. J Card Surg 2011; 26:268-70. [PMID: 21443731 DOI: 10.1111/j.1540-8191.2011.01223.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Behçet's disease is a rare autoimmune vasculitis that may cause coronary artery aneurysms. We discuss the evaluation and management decisions for a 19-year-old female with a giant rapidly expanding aneurysm of the proximal left anterior descending coronary artery and Behçet's disease.
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Affiliation(s)
- David G Greenhouse
- Department of Cardiothoracic Surgery, New York University School of Medicine, New York, NY, USA
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Lee SH, Chae JK, Choi JB, Lee SR, Rhee KS, Kim WH, Ko JK. Cardiovascular Behçet's Disease Presenting as a Subepicardial Hematoma: An Uneventful 2-Year Clinical Course. J Cardiovasc Ultrasound 2010; 18:108-11. [PMID: 20967160 DOI: 10.4250/jcu.2010.18.3.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 08/02/2010] [Accepted: 08/17/2010] [Indexed: 11/22/2022] Open
Abstract
Cardiovascular involvement in Behçet's disease is not uncommon and could be life-threatening. We describe here a 28-year-old man, who developed sudden onset chest pain during warfarinization due to deep vein thrombosis. Echocardiography and computed tomography showed a 60×60 mm-sized hematoma in the pericardial space compressing the right heart. Coronary angiography showed totally occluded proximal right coronary artery. The hematoma was located at the subepicardial plane of the right atrium on surgical view and successfully evacuated. Follow-up echocardiography revealed complete resolution of the hematoma. He is doing well for 24 months after surgery.
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Affiliation(s)
- Sun Hwa Lee
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
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La Regina M, Gasparyan AY, Orlandini F, Prisco D. Behçet's Disease as a Model of Venous Thrombosis. Open Cardiovasc Med J 2010; 4:71-7. [PMID: 20360979 PMCID: PMC2847254 DOI: 10.2174/1874192401004020071] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 11/23/2009] [Accepted: 12/12/2009] [Indexed: 01/11/2023] Open
Abstract
Behçet's disease (BD) is a chronic inflammatory disease of unknown aetiology characterized by recurrent oral, genital aphthous ulcerations, uveitis, skin lesions and other multisystem affections associated with vasculitis. Different types of vessels, predominantly veins, can be affected in BD. The frequency of vascular lesions in BD, such as superficial and deep venous thromboses, arterial aneurysms and occlusions, ranges between 7-29%. In this review, various factors of thrombogenesis in BD, particularly pro- and antithrombotic endothelial and non-endothelial factors, factors of coagulation, platelet activation and rheological changes are presented and discussed from positions of Virchow's triad of venous thrombosis. Despite advances in understanding of thrombogenesis in BD, still many issues of diagnosis and targeted preventive and therapeutic measures remain unresolved. Further studies are needed to clarify the pathobiology of BD-related thrombosis and to provide the clinicians with recommendations over the utility, safety and effectiveness of the antithrombotic therapy in BD.
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Affiliation(s)
- Micaela La Regina
- Department of Internal Medicine, Periodic Fevers Research Centre, Catholic University, Rome, Italy
| | | | | | - Domenico Prisco
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
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Regina ML, Gasparyan AY, Orlandini F, Prisco D. Behçet’s Disease as a Model of Venous Thrombosis. Open Cardiovasc Med J 2010. [DOI: 10.2174/1874192401004010071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Behçet’s disease (BD) is a chronic inflammatory disease of unknown aetiology characterized by recurrent oral, genital aphthous ulcerations, uveitis, skin lesions and other multisystem affections associated with vasculitis. Different types of vessels, predominantly veins, can be affected in BD. The frequency of vascular lesions in BD, such as superficial and deep venous thromboses, arterial aneurysms and occlusions, ranges between 7-29%.
In this review, various factors of thrombogenesis in BD, particularly pro- and antithrombotic endothelial and non-endothelial factors, factors of coagulation, platelet activation and rheological changes are presented and discussed from positions of Virchow’s triad of venous thrombosis.
Despite advances in understanding of thrombogenesis in BD, still many issues of diagnosis and targeted preventive and therapeutic measures remain unresolved. Further studies are needed to clarify the pathobiology of BD-related thrombosis and to provide the clinicians with recommendations over the utility, safety and effectiveness of the antithrombotic therapy in BD.
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11
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Sonia H, Khaldoun BH, Sylvia M, Faouzi M, Habib G, Mohamed BF. Stenosis and aneurysm of coronary arteries in a patient with Behçet's Disease. Open Cardiovasc Med J 2008; 2:118-20. [PMID: 19430524 PMCID: PMC2627529 DOI: 10.2174/1874192400802010118] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 11/20/2008] [Accepted: 11/24/2008] [Indexed: 12/14/2022] Open
Abstract
Coronary artery disease is extremely rare in patients with Behçet’s disease. We report the case of a patient with a history of Behçet’s disease who was admitted in our hospital with instable angina pectoris. The patient’s electrocardiogram was normal. Coronary angiography revealed aneurysm of the distal right coronary artery with a tight stenosis of the proximal part of the posterolateral branch. These two conditions were initially treated with immunosuppressive treatment. Three years later coronary angiography showed a total occlusion of the right coronary artery treated with medical therapy. More than fourteen cases of coronary involvement were reported in the literature but the etiopathogeny and the treatment are yet unknown
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Affiliation(s)
- Hammami Sonia
- Department of Internal Medicine, University Hospital "F. Bourguiba" Monastir (Tunisia).
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Kaya E, Saglam H, Ciftci I, Kulac M, Karaca S, Melek M. Evaluation of myocardial perfusion and function by gated SPECT in patients with Behçet's disease. Ann Nucl Med 2008; 22:287-95. [PMID: 18535879 DOI: 10.1007/s12149-007-0115-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Accepted: 12/13/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Behçet's disease (BD) is a systemic multi-system vasculitis that can have a wide range of effects on the cardiovascular system. OBJECTIVE To determine the existence of myocardial perfusion defects caused by coronary microvascular dysfunction in BD and to evaluate coronary arterial distribution and left ventricular systolic function by gated single-photon emission computed tomography (SPECT). METHODS The study population consisted of 23 (15 men and 8 women) patients with BD and 20 healthy controls (12 men and 8 women). Technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) gated SPECT studies were performed at stress and rest in a 2-day protocol. Stress and rest left ventricular ejection fraction (LVEF) were calculated. Using non-gated SPECT images myocardial perfusion scores [summed stress score (SSS), summed rest score (SRS), summed difference score (SDS), and fix defect score (FDS)] and perfusion defect extent as percentage (stress, rest ischemic, and fix %LV) were determined. Using gated SPECT images, wall motion score indices (stress wall motion score indices and rest wall motion score indices) were calculated. Coronary angiography (CAG) was applied to patients with abnormal myocardial perfusion scintigraphy (MPS). RESULTS The mean ages of the BD and control groups were 39.3 +/- 10.6 years and 36.2 +/- 8.3 years, respectively. No statistically significant differences were observed between the two groups regarding clinical features and cardiologic findings. Abnormal MPS was found in 13 (56.5%) of the BD patients; 3 patients had non-transmural infarcts and 10 patients reversible perfusion defects. Reversible perfusion defects were also found in two controls (10.0%). When the two groups were compared regarding the gated SPECT findings, differences were determined in the following parameters; SSS, SRS, SDS, FDS, stress and rest LVEF, stress and rest %LV, and stress and rest WMSI. In the BD group, when gated SPECT results were compared between those with and without abnormal MPS, differences were determined in SSS, SRS, SDS, FDS, stress and rest %LV, and stress and rest WMSI. Epicardial coronary arteries were normal in CAG. CONCLUSIONS Myocardial perfusion and function are disturbed owing to influenced coronary microvascularity in BD, and CAG is frequently observed to be normal. Gated SPECT is a non-invasive reliable method that simultaneously evaluates the existence, extent and severity of myocardial ischemia or infarction and the wall movements in cardio-Behçet.
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Affiliation(s)
- Eser Kaya
- Department of Nuclear Medicine, Faculty of Medicine, Afyon Kocatepe University, Inönü Bulvari, Afyonkarahisar, Turkey.
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Wennberg PW, Kalsi H. Aneurysms of the Peripheral Arteries. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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