Systemic sclerosis is associated with lower limb vascular stiffness and microvascular impairment: results from a prospective study.

Tytuł:: Systemic sclerosis is associated with lower limb vascular stiffness and microvascular impairment: results from a prospective study.
Autorzy:: Cassius C; Dermatology Department, APHP, Hôpital Tenon, F-75020, Paris, France. .; Dermatology Department, APHP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, F-75010, Paris, France. .; Université de Paris, Institut de Recherche Saint-Louis, INSERM U976-HIPI UNIT, F-75010, Paris, France. .
Seta V; Dermatology Department, APHP, Hôpital Cochin, F-75014, Paris, France.
Monfort JB; Dermatology Department, APHP, Hôpital Tenon, F-75020, Paris, France.
Baudot NA; Dermatology Department, APHP, Hôpital Tenon, F-75020, Paris, France.
Rivière S; Internal Medicine Department, APHP, Hôpital Saint-Antoine, F-75012, Paris, France.
Mekinian A; Internal Medicine Department, APHP, Hôpital Saint-Antoine, F-75012, Paris, France.
Frances C; Dermatology Department, APHP, Hôpital Tenon, F-75020, Paris, France.
Barbaud A; Dermatology Department, APHP, Hôpital Tenon, F-75020, Paris, France.
Senet P; Dermatology Department, APHP, Hôpital Tenon, F-75020, Paris, France.
Źródło:: Clinical rheumatology [Clin Rheumatol] 2021 Sep; Vol. 40 (9), pp. 3679-3686. Date of Electronic Publication: 2021 Mar 06.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Publication: <2008->: Heidelberg : Springer
Original Publication: Brussels : Acta Medica Belgica, [1982-
MeSH Terms:: Peripheral Arterial Disease*/complications
Scleroderma, Systemic*/complications
Vascular Stiffness*
Female ; Humans ; Lower Extremity ; Male ; Middle Aged ; Predictive Value of Tests ; Prospective Studies
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Contributed Indexing:: Keywords: Ankle-brachial index; Microangiopathy; Peripheral arterial disease; Systemic sclerosis; Toe-brachial index; Vascular stiffness
Entry Date(s):: Date Created: 20210306 Date Completed: 20210813 Latest Revision: 20240220
Update Code:: 20240221
DOI:: 10.1007/s10067-021-05672-0
PMID:: 33674989
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Objective: Systemic sclerosis (SSc) is a connective tissue disease characterized by microangiopathy. Peripheral arterial disease, increasingly studied during SSc, is responsible for digital ulcers, associated with a high risk of amputation. The aim of our study was to assess the frequency of lower limb arterial impairment in SSc patients by measuring ankle-brachial index (ABI), toe pressure (TP), and toe-brachial index (TBI).
Methods: Systemic sclerosis patients were included prospectively during 1 year in Tenon and Saint-Antoine Hospitals, Paris. Clinical and biological data were recorded. For each patient, ABI, TP, and TBI were measured and an arterial duplex ultrasonography was prescribed in case of abnormal results.
Results: Eighty-six patients were included (94% women, median age 62 years). Only 24% of them had no lower limb hemodynamic vascular abnormalities; 44% had an isolated microvascular abnormality (normal ABI and TBI<0.75); 31% had at least a macrovascular injury associated or not with microvascular impairment (abnormal ABI) and 12.6% had a TP<50 mmHg. During follow-up, there was a trend towards association of low TBI with more major adverse event (all-cause mortality, non-fatal stroke, non-fatal myocardial infarction, and lower limb ischemic manifestations) than normal TBI.
Conclusion: By measuring ABI and TP, we showed that 76% of SSc patients had hemodynamic arterial lower limb abnormalities related to macro- and/or microvascular impairment and that 28% had vascular stiffness. In SSc patients, ABI is not an accurate tool to detect lower limb arterial disease, likely due to underlying micro- and macrovascular changes. Key Points • The presence of lower limb macro-and/or microvascular involvement was detected in 76% of SSc patients. • In SSc patients, ABI is not an accurate tool to detect lower limb arterial disease, likely due to underlying microvascular changes and frequent arterial stiffness.
(© 2021. International League of Associations for Rheumatology (ILAR).)

Comment in: Front Biosci (Schol Ed). 2023 Dec 26;15(4):16. (PMID: 38163957)

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