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Peripheral microcirculatory abnormalities are associated with cardiovascular risk in systemic sclerosis: a nailfold video capillaroscopy study

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Abstract

Introduction

Microvascular dysfunction is the key element in the pathogenesis of systemic sclerosis (SSc), whereas the contribution of large and medium size vessel abnormalities is yet to be established. The aim of the present study is to assess the association between micro- and macrovascular function by utilizing a broad spectrum of assessments of vascular performance.

Methods

We included consecutive, consenting SSc patients who underwent nailfold video capillaroscopy (NVC) for microcirculation evaluation. Peripheral and central systolic and diastolic blood pressure, carotid intima-media thickness (cIMT), aortic augmentation index (AIx) corrected for a heart rate of 75 beats per minute (AIx-75), and carotid-femoral pulse wave velocity (PWV) were also performed to assess macrovascular function. Cardiovascular risk disease (CVD) algorithms were also calculated and included in the analysis.

Results

A total of 81 patients (6 males) were studied with mean age 55.44 ± 13.40 years. Reduced capillary density was inversely correlated with arterial stiffness (Alx-75) and augmentation pressure (r =  − 0.262, p = 0.018, and r =  − 0.249, p = 0.025 respectively). Alx was significantly lower in the early compared to late pattern (28.24 ± 11.75 vs 35.63 ± 10.47, p = 0.036). A significant trend was found among NVC patterns with Alx-75 values being higher with the progression of microangiopathy towards the “late” group (26.36 ± 10.90 vs 30.81 ± 11.59 vs 35.21 ± 7.90, p = 0.027 for trend). Similarly, Framingham risk score and Atherosclerotic Cardiovascular Disease score were progressively higher across the worsening NVC patterns (4.10 ± 4.13 vs 2.99 ± 2.72 vs 6.36 ± 5.65, p = 0.023, and 6.99 ± 7.18 vs 5.63 ± 4.41 vs 12.09 ± 9.90, p = 0.019, respectively, for trends). Finally, QRISK3 (10-year cardiovascular disease risk) and ASCVD (Atherosclerotic Cardiovascular Disease) scores were inversely correlated with the number of capillaries (r =  − 0.231, p = 0.048, and r =  − 0.260, p = 0.038 respectively).

Conclusion

These data suggest that CVD risk scores and macrovascular parameters are strongly correlated with microvasculopathy in patients with SSc.

Key Points

• Microangiopathy is the hallmark of SSc, but the relationship between subclinical atherosclerosis and small vessel disease remains unknown.

• Arterial stiffening and CVD risk scores are positively associated with the degree of progression of peripheral microvasculopathy assessed with NVC.

• The results of the study suggest an association between NVC abnormalities and higher CVD risk in SSc patients.

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Authors and Affiliations

  1. Fourth Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos Str. 49, Thessaloniki, Greece

    Eleni Pagkopoulou, Eva Triantafyllidou, Alexandra Arvanitaki, Alexandros Garyfallos & Theodoros Dimitroulas

  2. First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece

    Stergios Soulaidopoulos

  3. Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany

    Alexandra Arvanitaki

  4. Second Propedeutic Department of Internal Medicine, Medical School, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Niki Katsiki, Asterios Karagiannis & Michael Doumas

  5. Evangelismos Hemodialysis Unit, Veria, Greece

    Chalarampos Loutradis

  6. Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS FT, Dudley, UK

    George D. Kitas

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  1. Eleni Pagkopoulou
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Pagkopoulou, E., Soulaidopoulos, S., Triantafyllidou, E. et al. Peripheral microcirculatory abnormalities are associated with cardiovascular risk in systemic sclerosis: a nailfold video capillaroscopy study. Clin Rheumatol 40, 4957–4968 (2021). https://doi.org/10.1007/s10067-021-05795-4

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