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Silent cardiovascular involvement in patients with diffuse systemic sclerosis: a controlled cross‐sectional study
Author(s) -
Turiel Maurizio,
Gianturco Luigi,
Ricci Cristian,
SarziPuttini Piercarlo,
Tomasoni Livio,
Colonna Vito de Gennaro,
Ferrario Paolo,
Epis Oscar,
Atzeni Fabiola
Publication year - 2013
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.21819
Subject(s) - medicine , arterial stiffness , pulse wave velocity , cardiology , endothelial dysfunction , asymmetric dimethylarginine , systemic inflammation , subclinical infection , intima media thickness , blood pressure , inflammation , carotid arteries , biochemistry , chemistry , amino acid , arginine
Objective An association between systemic autoimmune diseases and atherosclerosis has been described in many connective tissue diseases, and this association is known to lead to increased cardiovascular morbidity and mortality. Systemic sclerosis (SSc) is characterized by multisystem organ inflammation, endothelial wall damage, and vasculopathy. There are many markers of endothelial dysfunction and/or atherosclerotic risk, such as asymmetric dimethylarginine (ADMA), arterial stiffness parameters, carotid intima‐media thickness (CIMT), and coronary flow reserve (CFR) assessed by transthoracic echocardiography. The aim of this pilot study was to use various endothelial and atherosclerosis markers to identify early cardiovascular involvement in a group of SSc patients. Methods The study involved 20 patients (2 men and 18 women with a mean ± SD age of 52.96 ± 12.51 years) with diffuse SSc who had no signs or symptoms of cardiovascular disease (CVD) and 20 age‐ and sex‐matched controls. All subjects underwent a dipyridamole echocardiographic stress test that included a determination of CFR and an evaluation of CIMT, arterial stiffness, and plasma ADMA levels. Results All of the arterial wall measurements of the patients with diffuse SSc were significantly different from those of the controls, and both right and left CIMT, pulse wave velocity, and stiffness index (β) were significantly elevated in the SSc patients compared to the healthy controls. Moreover, in patients with diffuse SSc, CFR was significantly lower ( P = 0.0033) and plasma ADMA levels were higher ( P < 0.0001) than in healthy controls. Conclusion SSc patients without any clinical evidence of CVD seem to have had subclinical atherosclerosis, which was suggested by early impairment of coronary microcirculation and macrovascular involvement.