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Increased Arterial Stiffness as the Marker of Vascular Involvement in Systemic Sclerosis

ORSOLYA TIMÁR, PÁL SOLTÉSZ, SZILVIA SZAMOSI, HENRIETTA DÉR, SÁNDOR SZÁNTÓ, ZOLTÁN SZEKANECZ, and GABRIELLA SZÜCS

ABSTRACT.

Objective. Endothelial dysfunction and vasculopathy of the small and large vessels are crucial pathogenic factors in systemic sclerosis (SSc). Accelerated atherosclerosis and impaired flow-mediated vasodilation have been described in SSc. We evaluated arterial stiffness in patients with SSc compared to healthy controls.

Methods. Augmentation index (AI) and pulse wave velocity (PWV) of the brachial artery were measured in 40 patients with SSc and 35 age and sex matched healthy controls using an arteriograph system.

Results. AI was significantly higher in SSc patients (9.02) compared to controls (–41.15) (p < 0.0001). PWV was similarly higher in patients with SSc (9.67 m/s) than in controls (8.00 m/s) (p = 0.0017). PWV was significantly higher in patients with localized SSc (10.04 ± 2.01 m/s) compared to those with diffuse SSc (8.39 ± 1.87 m/s) (p = 0.034). There was a significant, positive linear correlation between AI and PWV (r = 0.32, p = 0.045). We also observed significant correlations between AI and age (r = 0.31, p = 0.048), PWV and age (r = 0.36, p = 0.021), and PWV and disease duration (r = 0.40, p = 0.011) in SSc patients.

Conclusion. Increased AI and PWV of the aorta in comparison to age and sex matched healthy controls indicate increased large-vessel stiffness in patients with SSc. PWV and AI are reproducible indicators of the presence and degree of arterial stiffening. Because arterial stiffness may correlate with disease duration and age in patients with SSc, it may be a useful diagnostic test in the assessment of arterial function. Increased vascular stiffness may be therapeutically targeted by statins and other vasoprotective agents during the management of SSc. (First Release May 15 2008; J Rheumatol 2008;35:1329-33)

Key Indexing Terms:

SYSTEMIC SCLEROSIS
ATHEROSCLEROSIS
ARTERIAL STIFFNESS
AUGMENTATION INDEX
PULSE WAVE VELOCITY

From the Third Department of Medicine, Cardiovascular Unit and Rheumatology Division, University of Debrecen Medical Center, Debrecen, Hungary.

Supported by research grants T032947 (Dr. Szücs) and T048541 (Dr. Szekanecz) from the National Foundation for Scientific Research (OTKA), Medical Research Council grant 250/2006 (Dr. Soltész), and a Bolyai Research Grant (Dr. Soltész).

O. Timár, MD; P. Soltész, MD, PhD, Cardiovascular Unit; S. Szamosi, MD, Rheumatology Division; H. Dér, MD, Cardiovascular Unit; S. Szántó, MD, PhD; Z. Szekanecz, MD, PhD; G. Szücs, MD, PhD, Rheumatology Division.

Dr. Timár and Dr. Soltész contributed equally to this work.

Address reprint requests to Dr. G. Szücs, Third Department of Internal Medicine, Rheumatology Division, University of Debrecen, Medical and Health Science Center, Hungary Móricz Zs krt. 22, H-4004 Debrecen, Hungary. E-mail: szucsg@iiibel.dote.hu

Accepted for publication February 7, 2008.