Abstract
Background Vascular damage is recognized as a diagnostic landmark in systemic sclerosis (SSc), both in its limited and diffuse subtypes. Early detection at a subclinical stage with transthoracic echocardiography (TTE) and carotid femoral pulse wave velocity (cfPWV) may be helpful in therapeutic planning and management. Aim of the Study. The aim of the study was to evaluate presence of subclinical cardiovascular damage in patients with limited and diffuse SSc in comparison with a cohort of healthy individuals. Methods Consecutive patients with limited and diffuse SSc underwent complete TTE and cfPWV and a complete review of clinical data. As controls, 23 healthy subjects with similar hemodynamic profiles were selected. Results 41 patients (35 female, aged 56.9 years), 21 with diffuse and 20 with limited SSc, were recruited. Past medical history, cardiovascular risk factors, gender distribution, and disease duration were similar in the two groups as well as TTE parameters and hemodynamic indexes—cfPWV (6.5 [6–6.8] vs. 7.0 [6.2–8.5], p=0.24) and augmentation index (145.6 ± 14.2 vs. 149 ± 20.6, p=0.52). Patients with limited SSc were 10 years older than patients with diffuse SSc. In the multiple regression analysis, only age (p=0.0154) and disease duration (p=0.0467) resulted as the significant determinant of cfPWV. When compared to healthy controls, no significant difference emerged in TTE or hemodynamic indexes. Conclusion In SSc, cfPWV increases with age, with no additional impact of pathology or subtype. Vascular damage in the SSc population is not accurately reflected in increased arterial stiffness, as evaluated with cfPWV, or classically defined echocardiographic findings of organ damage (i.e., left ventricular concentric remodelling and increased filling pressures).
Highlights
Vascular damage is recognized as a diagnostic landmark in systemic sclerosis (SSc), both in its limited and diffuse subtypes
E aim of the study was to evaluate the presence of subclinical cardiac organ damage and arterial stiffness, as a landmark of macrovascular damage, with the current gold standard represented by transthoracic echocardiography and carotid femoral pulse wave velocity (cfPWV) in patients with SSc, focusing in particular on differences between limited and diffuse SSc
Echocardiography is one of the tools used for annual screening in systemic sclerosis patients, in order to detect patients at high risk for pulmonary arterial hypertension (PAH) at early stage
Summary
Vascular damage is recognized as a diagnostic landmark in systemic sclerosis (SSc), both in its limited and diffuse subtypes. E aim of the study was to evaluate presence of subclinical cardiovascular damage in patients with limited and diffuse SSc in comparison with a cohort of healthy individuals. Patients with limited SSc were 10 years older than patients with diffuse SSc. In the multiple regression analysis, only age (p 0.0154) and disease duration (p 0.0467) resulted as the significant determinant of cfPWV. E aim of the study was to evaluate the presence of subclinical cardiac organ damage and arterial stiffness, as a landmark of macrovascular damage, with the current gold standard represented by transthoracic echocardiography and cfPWV in patients with SSc, focusing in particular on differences between limited and diffuse SSc CfPWV has been shown to be higher in SSc patients than in healthy, age-matched controls in some [7,8,9] but not all [9, 10] previous works. e specific role of SSc in promoting arterial stiffening is still unclear, as well as impact
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