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Corrado A, Mansueto N, Correale M, Rella V, Tricarico L, Altomare A, Brunetti ND, Cantatore FP, Rotondo C. Flow Mediated Dilation in Systemic Sclerosis: Association with clinical findings, capillaroscopic patterns and endothelial circulating markers. Vascul Pharmacol 2024; 154:107252. [PMID: 38061409 DOI: 10.1016/j.vph.2023.107252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/19/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023]
Abstract
AIM Endothelial dysfunction represents a key feature of the pathological process underlying micro and macro-vascular damage in Systemic Sclerosis (SSc). This study aims to improve knowledge of the physiopathology of vascular damage in SSc through the assessment of the endothelial dysfunction by Flow Mediated Dilation (FMD) and serum levels of circulating endothelial dysfunction markers and the correlation of macrovascular damage with clinical findings and microvascular capillaroscopic patterns. METHODS 57 SSc patients and 37 healthy subjects were recruited. All included subjects underwent radial artery FMD test and Nailfold Video-Capillaroscopy; serum levels of Vascular Endothelial Growth Factor (VEGF), Vascular Cell Adhesion Molecule-1 (VCAM-1) and angiopoietin-2 were evaluated. RESULTS Compared to healthy subjects, in SSc patients lower FMD and higher time needed to obtain the maximal FMD responsewere observed, whereas serum levels of VEGF, VCAM-1, and angiopoietin-2 were significantly higher. The impairment of FMD values was associated with disease duration, pulmonary arterial hypertension, and digital ulcers and correlates with greater microvascular damage evaluated by Nailfold Video-Capillaroscopy… An inverse relationship between VEGF, angiopoietin-2, VCAM-1 levels and FMD was observed, but only VEGF and angiopoietin-2 were significantly higher in patients with digital ulcers and pulmonary arterial hypertension. CONCLUSIONS FMD ultrasound test and circulating levels of endothelial dysfuncion markers could be useful as biomarkers of vasculopathy and could be a helpful tool in the overall assessment of vascular injury in Systemic Sclerosis patients.
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Affiliation(s)
- Addolorata Corrado
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, Foggia, Italy.
| | - Natalia Mansueto
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, Foggia, Italy
| | - Michele Correale
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, Foggia, Italy
| | - Valeria Rella
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, Foggia, Italy
| | - Lucia Tricarico
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, Foggia, Italy
| | - Alberto Altomare
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, Foggia, Italy
| | - Natale Daniele Brunetti
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, Foggia, Italy
| | - Francesco Paolo Cantatore
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, Foggia, Italy
| | - Cinzia Rotondo
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, Foggia, Italy
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Moroni L, Selmi C, Angelini C, Meroni PL. Evaluation of Endothelial Function by Flow-Mediated Dilation: a Comprehensive Review in Rheumatic Disease. Arch Immunol Ther Exp (Warsz) 2017; 65:463-475. [DOI: 10.1007/s00005-017-0465-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 03/03/2017] [Indexed: 12/18/2022]
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Abstract
Systemic sclerosis (SSc) is a multisystem connective tissue disorder featured by vascular injury and fibrosis of the skin and various internal organs with autoimmune background. Although the pathogenesis of SSc still remains elusive, it is generally accepted that initial vascular injury due to autoimmunity and/or environmental factors causes structural and functional abnormalities of vasculature which eventually result in the constitutive activation of fibroblasts in various organs. Structural alterations consist of destructive vasculopathy (loss of small vessels) and proliferative obliterative vasculopathy (occlusion of arterioles and small arteries with fibro-proliferative change) caused by impaired compensatory vasculogenesis and angiogenesis. Impaired function of SSc vasculature includes the altered expression of cell adhesion molecules predominantly inducing Th2 and Th17 cell infiltration, endothelial dysfunction primarily due to the low availability of nitric oxide, the activated endothelial-to-mesenchymal transition leading to fibro-proliferative vascular change and tissue fibrosis, and the impaired coagulation/fibrinolysis system promoting the formation of intravascular fibrin deposits. Recent new insights into the therapeutic mechanisms of intravenous cyclophosphamide pulse and bosentan and the establishment of a new SSc animal model (Klf5 (+/-);Fli1 (+/-) mice) provide us useful clues to further understand the development of vascular alterations characteristic of SSc. This article overviewed the present understanding of the pathogenesis of SSc vasculopathy.
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Frech T, Walker AE, Barrett-O'Keefe Z, Hopkins PN, Richardson RS, Wray DW, Donato AJ. Systemic sclerosis induces pronounced peripheral vascular dysfunction characterized by blunted peripheral vasoreactivity and endothelial dysfunction. Clin Rheumatol 2014; 34:905-13. [PMID: 25511849 DOI: 10.1007/s10067-014-2834-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 10/15/2014] [Accepted: 11/17/2014] [Indexed: 01/19/2023]
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.
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Affiliation(s)
- Tracy Frech
- Department of Internal Medicine, Division of Rheumatology, University of Utah, Veterans Affair Medical Center, Salt Lake City, UT, USA
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Takahashi T, Asano Y, Amiya E, Hatano M, Tamaki Z, Takata M, Ozeki A, Watanabe A, Kawarasaki S, Taniguchi T, Ichimura Y, Toyama T, Watanabe M, Hirata Y, Nagai R, Komuro I, Sato S. Clinical correlation of brachial artery flow-mediated dilation in patients with systemic sclerosis. Mod Rheumatol 2013; 24:106-11. [DOI: 10.3109/14397595.2013.854064] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Takehiro Takahashi
- Department of Dermatology, University of Tokyo Graduate School of Medicine,
7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yoshihide Asano
- Department of Dermatology, University of Tokyo Graduate School of Medicine,
7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine,
Tokyo, Japan
| | - Masaru Hatano
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine,
Tokyo, Japan
| | - Zenshiro Tamaki
- Department of Dermatology, University of Tokyo Graduate School of Medicine,
7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Munenori Takata
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine,
Tokyo, Japan
| | - Atsuko Ozeki
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine,
Tokyo, Japan
| | - Aya Watanabe
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine,
Tokyo, Japan
| | - Shuichi Kawarasaki
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine,
Tokyo, Japan
| | - Takashi Taniguchi
- Department of Dermatology, University of Tokyo Graduate School of Medicine,
7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yohei Ichimura
- Department of Dermatology, University of Tokyo Graduate School of Medicine,
7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Tetsuo Toyama
- Department of Dermatology, University of Tokyo Graduate School of Medicine,
7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Masafumi Watanabe
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine,
Tokyo, Japan
| | - Yasunobu Hirata
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine,
Tokyo, Japan
| | - Ryozo Nagai
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine,
Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine,
Tokyo, Japan
| | - Shinichi Sato
- Department of Dermatology, University of Tokyo Graduate School of Medicine,
7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Takahashi T, Asano Y, Amiya E, Hatano M, Tamaki Z, Takata M, Ozeki A, Watanabe A, Kawarasaki S, Taniguchi T, Ichimura Y, Toyama T, Watanabe M, Hirata Y, Nagai R, Komuro I, Sato S. Clinical correlation of brachial artery flow-mediated dilation in patients with systemic sclerosis. Mod Rheumatol 2013. [PMID: 23543079 DOI: 10.1007/s10165-013-0867-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 03/07/2013] [Indexed: 01/10/2023]
Abstract
OBJECTIVE: To investigate the clinical significance of flow-mediated dilation (FMD) in systemic sclerosis (SSc). METHODS: Thirty-three SSc patients and 12 healthy controls were studied. Ultrasound assessment of the brachial artery FMD was performed on all subjects. The results were expressed as the percentage of increase in brachial artery diameter following hyperemia. RESULTS: Limited cutaneous SSc (lcSSc) patients had significantly lower FMD values than healthy controls (5.3 ± 2.7 versus 7.7 ± 2.0 %, p < 0.05), while the values in diffuse cutaneous SSc (dcSSc) patients (6.7 ± 4.0 %) were comparable to those in lcSSc patients and healthy controls. Although FMD values did not correlate with any clinical features in dcSSc patients, there was an inverse correlation between FMD values and disease duration in lcSSc patients (r = -0.64, p < 0.05). Furthermore, lcSSc patients with decreased FMD values showed significantly higher prevalence of digital ulcers and elevated right ventricular systolic pressure than those with normal values (for each; 75 versus 10 %, p < 0.05). CONCLUSION: The FMD values represent the severity of vascular damages, which progress along with disease duration and lead to digital ulcers and pulmonary arterial hypertension, in lcSSc patients.
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Affiliation(s)
- Takehiro Takahashi
- Department of Dermatology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Saglam M, Bozlar U, Kantarci F, Ay H, Battal B, Coskun U. Effect of hyperbaric oxygen on flow-mediated vasodilation: an ultrasound study. J Ultrasound Med 2008; 27:209-214. [PMID: 18204011 DOI: 10.7863/jum.2008.27.2.209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the effect of hyperbaric oxygen (HBO) treatment on flow-mediated vasodilation (FMD) by ultrasound examination. METHODS We studied 14 young patients without cardiovascular problems who underwent HBO treatment. The indications for HBO treatment were osteomyelitis (n = 8), Crohn disease (n = 2), perianal abscesses (n = 2), lingual artery embolization (n = 1), and aseptic necrosis (n = 1). The ultrasound evaluation for FMD was performed before HBO treatment, after 1 session of HBO treatment, and after 10 sessions of HBO treatment. The right brachial artery FMD response was evaluated by the mean of the baseline right brachial artery diameter, absolute change in the diameter before and after cuff inflation/deflation, and percent change in the diameter. RESULTS Statistical analysis showed a significant change in the preinflation right brachial artery diameter before (mean +/- SD, 3.6 +/- 0.54 mm) and after (3.76 +/- 0.56 mm) 10 sessions of HBO treatment (P < .05). The absolute changes in the right brachial artery diameter before and after cuff inflation/deflation (0.36 +/- 0.2 mm before HBO treatment, 0.37 +/- 0.22 mm after 1 session of HBO treatment, and 0.38 +/- 0.21 mm after 10 sessions) and percent change in FMD (10% +/- 5.8% before HBO treatment, 10.6% +/- 7.5% after 1 session of HBO treatment, and 10.6% +/- 7.7% after 10 sessions) after induction of a hyperemic response by cuff inflation were not statistically significant (P > .05). CONCLUSIONS Hyperbaric oxygen treatment did not have an immediate effect on FMD (absolute change in the right brachial artery diameter after cuff inflation/deflation); however, the right brachial artery diameter increased after 10 sessions of HBO treatment. This may suggest chronic stress on the vascular endothelium after HBO.
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Affiliation(s)
- Mutlu Saglam
- Department of Radiology, Gulhane School of Medicine, Ankara, Turkey.
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