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Introduction Vasculopathy accounts for significant morbidity and mortality in systemic sclerosis (SSc). The aim of this project is studying the interplay between the microvascular and the macrovascular components.Material and Methods Three cohorts of sex- and age-matched patients were included: SSc fulfilling 2013 EULAR/ACR criteria, Very Early Diagnosis of Systemic Sclerosis (VEDOSS), Primary Raynaud’s Phenomenon (PRP). Cardiovascular disease (CVD) and pulmonary arterial hypertension (PAH) were exclusion criteria.All participants underwent clinical examination and laboratory/instrumental assessment including flow-mediated dilation (FMD) of brachial artery, arterial ultrasound color-Doppler examination of carotid, abdominal and lower limb vessels, ankle-brachial index (ABI), flow cytometry count of circulating endothelial cells (CEC), ELISA of markers of endothelial/vascular function (Von Willebrand factor [vWF], Intercellular adhesion molecule 1 [ICAM-1], Vascular cell adhesion molecule 1 [VCAM-1]) .Differences between groups were assessed by Kruskal-Wallis and Chi square tests. Correlation between variables was assessed by Spearman test.Results 34 patients with SSc (lcSSc n=21, dcSSc n=13), 14 with VEDOSS, 14 with PRP were enrolled. All were females. There were no significant differences in the median 10-year risk of fatal and nonfatal CVD events assessed by SCORE2 (SSc 2.1%, VEDOSS 1.5%, PRP 1.6%, p=0.680) and the proportion of subjects with increased Intimal Media Thickness (IMT) (>0.9) (SSc 11.7%, VEDOSS 7.1%, PRP 7.1%, p=0.829). However, patients with SSc (52.9%) and VEDOSS (50%) displayed a higher rate of atherosclerosis (defined as the presence of carotid, aortic or lower limb arterial plaques, stenosis, occlusions, aneurysmal dilatation >3 cm) compared to PRP (21.4%, p=0.12).Serum VCAM-1 levels were significantly higher in SSc compared to PRP, alike ICAM-1 and VCAM-1 in SSc compared to VEDOSS. Cec levels were significantly increased in ssc compared to prp but not vedoss (figure 1).Upon stratification of all the enrolled subjects in two cohorts, with (n=28) or without (n=34) atherosclerotic disease, no differences in median IMT and SCORE2 were observed. However, patients with atherosclerotic disease showed lower median FMD (5.6% vs 8.4%, p=0.04), more severe capillaroscopic findings (p=0.037) and higher VCAM-1 (1189.9 ng/ml vs 867.4 ng/ml, p=0.01).Conclusions We found a higher atherosclerotic burden affecting likewise VEDOSS and SSc, implying an early macrovascular damage in the disease course. However, this early atherogenic process seemed to be independent of endothelial dysfunction, since increase of endothelial activation markers and circulating endothelial cells became significant only in later phases. The apparent dissociation between microvascular and macrovascular damage in the VEDOSS cohort deserves further analysis in larger, multicentric cohorts.Abstract P.076 Figure 1(A) Percentage of circulating endothelial cels [CEC] in total cell population, (B) serum levels of vascular cell adhesion molecule [VCAM] and (C) serum levels of intercellular adhesion molecle [ICAM] in PRP, VEDO55 and S5c patients, Da ta are shown as dot plots with median. Each dot represents an individual. Kruskal-Wallis test was used for statistical analysis.