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Boutigny A, Mohamedi N, Pardo SJ, Bonnin S, Ketfi C, Ghaouti H, Viana V, Frazier A, Roos C, Burlacu R, Comarmond C, Kubis N, Sène D, Bonnin P. Impairment of central retinal artery hemodynamics in affected and fellow eyes in giant cell arteritis patients with unilateral vision loss. Autoimmun Rev 2023; 22:103272. [PMID: 36649878 DOI: 10.1016/j.autrev.2023.103272] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Permanent visual impairment is a major complication of giant cell arteritis (GCA). We investigated the added value of color Doppler imaging (CDI) of the central retinal artery (CRA) in patients with suspected GCA for early risk evaluation before temporal artery biopsy (TAB) results become available. METHODS We conducted a non-interventional observational study of 30 consecutive patients hospitalized for suspected GCA, including a comprehensive analysis of clinical, laboratory, imaging, CDI and pathology data. GCA was diagnosed or excluded (GCA+, GCA-, respectively) according to American College of Rheumatology (ACR) criteria and TAB findings. Three patients not meeting ACR criteria were excluded secondarily. The GCA- group contained ten patients, and the GCA+ group contained 17 patients, including eight with unilateral, transient or permanent clinical visual impairment (CVI). RESULTS Mean blood flow velocity (mBFV) in the CRA was impaired in the affected eyes of GCA + CVI+ patients (1.9 ± 0.9 cm.s-1, p < 0.001) relative to controls (4.1 ± 1.0 cm.s-1), GCA- patients (3.6 ± 0.7 cm.s-1) and GCA + CVI- patients (3.8 ± 0.8 cm.s-1). The mBFVs of the CRA was similar for affected and fellow eyes (right or left). CRA mBFV measurements effectively differentiated between patients with and without CVI (ROC-curve analysis, AUC = 0.925 [95%CI: 0.700 to 0.996], p < 0.0001, 88% sensitivity, 89% specificity, and cutoff of ≤2.7 cm.s-1 for affected eyes; 75% sensitivity, 100% specificity and cutoff of ≤2.2 cm.s-1 for fellow eyes). CONCLUSION CDI facilities the early detection of visual ischemia risk in GCA+ patients, justifying urgent high-dose corticosteroid administration to save at least the fellow eye before pathology results become available.
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Affiliation(s)
- Alexandre Boutigny
- Physiologie Clinique - Explorations Fonctionnelles, Université Paris Cité, AP-HP, Hôpital Lariboisière, F-75010 Paris, France; UMR1148 - LVTS, INSERM, Université Paris Cité, Hôpital Bichat, F-75018 Paris, France
| | - Nassim Mohamedi
- Physiologie Clinique - Explorations Fonctionnelles, Université Paris Cité, AP-HP, Hôpital Lariboisière, F-75010 Paris, France
| | - Sarah Jeanne Pardo
- Physiologie Clinique - Explorations Fonctionnelles, Université Paris Cité, AP-HP, Hôpital Lariboisière, F-75010 Paris, France
| | - Sophie Bonnin
- Ophtalmologie, Université Paris Cité, AP-HP, Hôpital Lariboisière, F-75010 Paris, France
| | - Chahinez Ketfi
- Physiologie Clinique - Explorations Fonctionnelles, Université Paris Cité, AP-HP, Hôpital Lariboisière, F-75010 Paris, France
| | - Hichem Ghaouti
- Physiologie Clinique - Explorations Fonctionnelles, Université Paris Cité, AP-HP, Hôpital Lariboisière, F-75010 Paris, France
| | - Vincent Viana
- Physiologie Clinique - Explorations Fonctionnelles, Université Paris Cité, AP-HP, Hôpital Lariboisière, F-75010 Paris, France
| | - Aline Frazier
- Rhumatologie, Université Paris Cité, AP-HP, Hôpital Lariboisière, F-75010 Paris, France
| | - Caroline Roos
- Urgences Céphalée, Université Paris Cité, AP-HP, Hôpital Lariboisière, F-75010 Paris, France
| | - Ruxandra Burlacu
- Médecine interne, Université de Paris Cité, AP-HP, Hôpital Lariboisière, F-75010 Paris, France
| | - Chloé Comarmond
- Médecine interne, Université de Paris Cité, AP-HP, Hôpital Lariboisière, F-75010 Paris, France
| | - Nathalie Kubis
- Physiologie Clinique - Explorations Fonctionnelles, Université Paris Cité, AP-HP, Hôpital Lariboisière, F-75010 Paris, France; UMR1148 - LVTS, INSERM, Université Paris Cité, Hôpital Bichat, F-75018 Paris, France
| | - Damien Sène
- Médecine interne, Université de Paris Cité, AP-HP, Hôpital Lariboisière, F-75010 Paris, France
| | - Philippe Bonnin
- Physiologie Clinique - Explorations Fonctionnelles, Université Paris Cité, AP-HP, Hôpital Lariboisière, F-75010 Paris, France; UMR1148 - LVTS, INSERM, Université Paris Cité, Hôpital Bichat, F-75018 Paris, France.
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