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Accelerated atherosclerosis in ANCA ‐associated vasculitis
Author(s) -
GonzálezSuárez I.,
RíosBlanco J. J.,
Arpa J.
Publication year - 2017
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.12787
Subject(s) - vasculitis , medicine , anca associated vasculitis , pathology , cardiology , disease
Objectives Cardiovascular disease, including myocardial infarction and stroke, is a major cause of mortality in ANCA ‐associated vasculitis ( AAV ). Although AAV affects small vessels, an accelerated atherosclerosis not explained by traditional cardiovascular risk factors ( CVRF ) has been demonstrated. We aimed to investigate the association of atherosclerosis measured by carotid intima‐media thickness ( CIMT ) and cerebral small vessel disease in AAV ‐patients. Materials & Methods Twenty‐three AAV ‐patients in complete remission were recruited. Carotid ultrasonography ( US ), transcranial Doppler ( TCD ), brain magnetic resonance imaging ( MRI ), and SPECT after intravenous administration of tracer 99mTc‐ HMPAO (dose: 720 MB q) were performed. Results AAV ‐patients presented higher CIMT compared to normative population. Multivariate linear regression analysis demonstrated an association of higher CIMT with increased pulsatility index in middle cerebral artery ( PI ‐ MCA ) ( P =.011), higher lesion load on ARWMC scale ( P =.011) and abnormal SPECT ( P =.008). No association between higher CIMT and CVRF (diabetes or hypertension) was demonstrated. Increasing internal carotid artery pulsatility index ( PI ‐ ICA ) was associated with decreasing mean flow velocity ( MFV )‐ MCA ( P =.038), increasing PI ‐ MCA ( P =.008) and increasing white matter lesions on MRI ( P =.011). Conclusions Our study adds weight to the presence of increased atherosclerosis in AAV ‐patients. The association observed between CIMT and PI ‐ ICA with small vessel cerebral disease, points the possible association of easy to use carotid US in predicting microvascular brain injury.