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Clinical aspects

 

Evaluation of endothelial dysfunction and clinical events in patients with early-stage vasculopathy in limited systemic sclerosis


1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11

 

  1. Division of Angiology, Department of Internal Medicine, Medical University of Graz, Austria. philipp.jud@medunigraz.at
  2. Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria.
  3. Department Centre of Medical Research, Medical University of Graz, Austria.
  4. Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria.
  5. Division of Pulmonology, Department of Internal Medicine, Ludwig Boltzmann Institute for Lung Vascular Research and Medical University of Graz, Austria.
  6. Division of Pulmonology, Department of Internal Medicine, Ludwig Boltzmann Institute for Lung Vascular Research and Medical University of Graz, Austria.
  7. Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria.
  8. Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Austria.
  9. Division of Rheumatology, Department of Internal Medicine, Medical University of Graz, Austria.
  10. Division of Angiology, Department of Internal Medicine, Medical University of Graz, Austria.
  11. Division of Angiology, Department of Internal Medicine, Medical University of Graz, Austria.

CER14692
2021 Vol.39, N°4 ,Suppl.131
PI 0057, PF 0065
Clinical aspects

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PMID: 34323684 [PubMed]

Received: 04/04/2021
Accepted : 25/06/2021
In Press: 28/07/2021
Published: 28/07/2021

Abstract

OBJECTIVES:
Limited cutaneous systemic sclerosis (lcSSc) is characterised by vasculopathy contributing to vascular apoptosis, structural and functional changes. The aim of this study was to investigate parameters of endothelial dysfunction and their association to clinical events in lcSSc patients with early-stage vasculopathy.
METHODS:
Patients with lcSSc and early-stage vasculopathy defined as absent pre-existing pulmonary arterial hypertension (PAH), digital ulcers, and symptomatic cardiovascular diseases were recruited together with age-, race- and sex-matched controls with primary Raynaud’s phenomenon. All subjects underwent measurements of flow-mediated (FMD) and nitroglycerine-mediated dilation (NMD), pulse-wave analysis, and biochemical analysis, including arginine, homoarginine, citrulline, ornithine, asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), and endothelial microparticles (EMP). Clinical events, including EUSTAR index, sicca symptoms, microvascular, skin, renal, gastrointestinal, and pulmonary involvement, were recorded by medical history, physical examination, laboratory parameters, disease-specific questionnaire, electrocardiogram, diagnostic imaging and spirometry.
RESULTS:
38 patients with lcSSc and 38 controls were included after screening for eligibility. There was no difference in FMD (p=0.775), NMD (p=0.303), aortic pulse-wave velocity (p=0.662) or in augmentation index (p=0.600) between patients with lcSSc and controls. Higher values of ADMA (p=0.030), SDMA (p=0.025) and borderline significantly higher values for CD31+/CD42b- EMP (p=0.062) were observed in lcSSc patients, also with positive correlations between those parameters. ADMA, SDMA and CD31+/CD42b- were correlated with subclinical PAH, nephropathy and capillary changes.
CONCLUSIONS:
Selected parameters of endothelial dysfunction contribute to clinical events in lcSSc patients with early-stage vasculopathy and endothelial dysfunction seems to be primarily present in microvasculature, while its impact on macrovascular changes in lcSSc is still indistinct.

DOI: https://doi.org/10.55563/clinexprheumatol/243mpp

Rheumatology Article