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Systemic sclerosis induces pronounced peripheral vascular dysfunction characterized by blunted peripheral vasoreactivity and endothelial dysfunction.
Clin Rheumatol. 2015 May; 34(5):905-13.CR

Abstract

Systemic sclerosis (SSc) vasculopathy can result in a digital ulcer (DU) and/or pulmonary arterial hypertension (PAH). We hypothesized that bedside brachial artery flow-mediated dilation (FMD) testing with duplex ultrasound could be used in SSc patients to identify features of patients at risk for DU or PAH. Thirty-eight SSc patients were compared to 52 age-matched healthy controls from the VAMC Utah Vascular Research Laboratory. Peripheral hemodynamics, arterial structure, and endothelial function were assessed by duplex ultrasound. A blood pressure cuff was applied to the forearm and 5-min ischemia was induced. Post-occlusion, brachial artery vascular reactivity (peak hyperemia/area under the curve [AUC]), shear rate, and endothelial function (FMD) were measured. SSc patients had smaller brachial artery diameters (p < 0.001) and less reactive hyperemia (p < 0.001), peak shear rate (p = 0.03), and brachial artery FMD (p < 0.001) compared with healthy controls. Brachial artery FMD was lower (p < 0.05) in SSc patients with DU. Tertile analysis suggested the 2 lower FMD tertiles (<5.40 %) had a 40-50 % chance of presenting with DU while the SSc patients with highest FMD tertile (>5.40 %) had less than 15 % chance of DU. All brachial artery FMD measurements were similar between SSc patients with and without PAH (all p > 0.05). Compared to healthy controls, SSc patients had significantly smaller brachial artery diameter and blunted peripheral vascular reactivity and endothelial function. SSc patients with DU have even greater impairments in endothelial function compared to those without DU. FMD testing has clinical utility to identify SSc patients at risk for DU.

Authors+Show Affiliations

Department of Internal Medicine, Division of Rheumatology, University of Utah, Veterans Affair Medical Center, Salt Lake City, UT, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

25511849

Citation

Frech, Tracy, et al. "Systemic Sclerosis Induces Pronounced Peripheral Vascular Dysfunction Characterized By Blunted Peripheral Vasoreactivity and Endothelial Dysfunction." Clinical Rheumatology, vol. 34, no. 5, 2015, pp. 905-13.
Frech T, Walker AE, Barrett-O'Keefe Z, et al. Systemic sclerosis induces pronounced peripheral vascular dysfunction characterized by blunted peripheral vasoreactivity and endothelial dysfunction. Clin Rheumatol. 2015;34(5):905-13.
Frech, T., Walker, A. E., Barrett-O'Keefe, Z., Hopkins, P. N., Richardson, R. S., Wray, D. W., & Donato, A. J. (2015). Systemic sclerosis induces pronounced peripheral vascular dysfunction characterized by blunted peripheral vasoreactivity and endothelial dysfunction. Clinical Rheumatology, 34(5), 905-13. https://doi.org/10.1007/s10067-014-2834-5
Frech T, et al. Systemic Sclerosis Induces Pronounced Peripheral Vascular Dysfunction Characterized By Blunted Peripheral Vasoreactivity and Endothelial Dysfunction. Clin Rheumatol. 2015;34(5):905-13. PubMed PMID: 25511849.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Systemic sclerosis induces pronounced peripheral vascular dysfunction characterized by blunted peripheral vasoreactivity and endothelial dysfunction. AU - Frech,Tracy, AU - Walker,Ashley E, AU - Barrett-O'Keefe,Zachary, AU - Hopkins,Paul N, AU - Richardson,Russell S, AU - Wray,D Walter, AU - Donato,Anthony J, Y1 - 2014/12/16/ PY - 2014/09/11/received PY - 2014/11/17/accepted PY - 2014/10/15/revised PY - 2014/12/17/entrez PY - 2014/12/17/pubmed PY - 2016/1/16/medline SP - 905 EP - 13 JF - Clinical rheumatology JO - Clin. Rheumatol. VL - 34 IS - 5 N2 - Systemic sclerosis (SSc) vasculopathy can result in a digital ulcer (DU) and/or pulmonary arterial hypertension (PAH). We hypothesized that bedside brachial artery flow-mediated dilation (FMD) testing with duplex ultrasound could be used in SSc patients to identify features of patients at risk for DU or PAH. Thirty-eight SSc patients were compared to 52 age-matched healthy controls from the VAMC Utah Vascular Research Laboratory. Peripheral hemodynamics, arterial structure, and endothelial function were assessed by duplex ultrasound. A blood pressure cuff was applied to the forearm and 5-min ischemia was induced. Post-occlusion, brachial artery vascular reactivity (peak hyperemia/area under the curve [AUC]), shear rate, and endothelial function (FMD) were measured. SSc patients had smaller brachial artery diameters (p < 0.001) and less reactive hyperemia (p < 0.001), peak shear rate (p = 0.03), and brachial artery FMD (p < 0.001) compared with healthy controls. Brachial artery FMD was lower (p < 0.05) in SSc patients with DU. Tertile analysis suggested the 2 lower FMD tertiles (<5.40 %) had a 40-50 % chance of presenting with DU while the SSc patients with highest FMD tertile (>5.40 %) had less than 15 % chance of DU. All brachial artery FMD measurements were similar between SSc patients with and without PAH (all p > 0.05). Compared to healthy controls, SSc patients had significantly smaller brachial artery diameter and blunted peripheral vascular reactivity and endothelial function. SSc patients with DU have even greater impairments in endothelial function compared to those without DU. FMD testing has clinical utility to identify SSc patients at risk for DU. SN - 1434-9949 UR - https://www.unboundmedicine.com/medline/citation/25511849/Systemic_sclerosis_induces_pronounced_peripheral_vascular_dysfunction_characterized_by_blunted_peripheral_vasoreactivity_and_endothelial_dysfunction_ L2 - https://dx.doi.org/10.1007/s10067-014-2834-5 DB - PRIME DP - Unbound Medicine ER -