Assessment of left atrial deformation parameters in familial mediterranean fever patients

Familial Mediterranean Fever (FMF), is an autosomal recessive, systemic inflammatory, self-limiting disease that is characterized by repeated at irregular intervals and peritonitis with fever, synovitis, pleuritis, pericarditis, arthritis and skin lesions. Especially, the studies which detected high levels of CRP, IL-6, IL-8 in non-attack period, suggest that subclinical inflammation is continued in FMF patients during this asymptomatic period of disease. There are many studies which show cardiovascular impaction and autonomic dysfunction in autoimmune rheumatic diseases. The cardiac conduction system damage and cardiac arrhythmias have an important place in these disease. FMF is a chronic inflammatory disease of clinical and subclinical cardiovascular effects have been demonstrated in many studies. These patients are at risk for cardiovascular involvement. The purpose of this study, to try to evaluate the effect of FMF on left atrial deformation parameters trough comparing both healthy subjects and FMF patients who are not in period of attack. Healthy controls and the patients diagnosed as FMF and applicant to the units of Akdeniz University Faculty of Medicine for an reason were evaluated in terms of compliance and included in the study. 40 FMF patients appropriate for criterias (24 male, 16 female) and a control group of 30 subjects (19 male, 11 female) were included. The basic characteristics were similar between groups. Only CRP levels in laboratory parameters were found to be increased in a meaningful way in FMF patients although in the normal reference range. When the conventional echocardiographic findings compared; EDT, IVRT and MPI were found higher in FMF group and it was seen that these values are statistically significant. Compared Doppler echocardiography findings, there were no significant differences between the two groups. Atrial electromechanical delay time data were compared in both groups and significant intraatrial and interatrial electromechanical delay in FMF patients was found to be longer. When compared between the two groups, P max and PWD were found to be significantly longer duration in the FMF group, Pmin was observed to be statistically significant lower in FMF group. Compared two groups of left atrial volume, only the left atrial maximum volume showed an increase in FMF patients to be statistically significant. There were no significant difference in other volumetric parameters between two groups. Left atrial mechanical function was found similar in both groups. It found no difference in the conventional parameters calculated in this way may be insufficient to rule out cardiovascular involvement. In this study, the left atrial deformation parameters were examined to assess the potential early cardiac impaction. Left atrial contraction reservoir and strain values as left atrial deformation parameters were significantly lower in the FMF group. Although the strain value showing the atrial conduction function is less in FMF group this difference was not statistically significant. On this subject it has not been previously observed in the literature. Based on the findings shown in previous studies, the situation could be expected compensatory increase in response to reduction in atrial reserve and transmission function such as in hypertension and senility. But in our study, atrial contraction function was found to be statistically lower than the passive transmission function. The reason for this, it may thought that inflammatory process because of the FMF may have affected mainly the atrial myocardium and affected the function of contraction. There were no significant finding in the correlation analysis of deformation parameters. At this point; we believe that there are some limitations such as; the small number of patients, inability to reach all of the genetic markers and limitations for further investigations such as magnetic resonance imaging which shows cardiac amyloidosis and atrial fibrosis. These results suggest that conventional echocardiographic findings may be insufficient to demonstrate cardiac dysfunction in the early stages of the FMF patients. With this study we have shown that use of the left atrium deformation parameters can be used to determine the left atrial involvement in FMF patients in early stages. Therefore, we believe that the cardiac involvement should be examined periodically through cardiologic examination of FMF patients at an early stage. In this way, the morbidity and mortality can be prevented with the early detection of FMF-related cardiovascular complications and taking the necessary preventive measures, in addition quality of life can also be increased. We believe that this results should be supported by a larger group of patients and long-term follow-up studies