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Sonaglioni A, Caminati A, Nicolosi GL, Lombardo M, Harari S. Incremental prognostic value of arterial elastance in mild-to-moderate idiopathic pulmonary fibrosis. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1473-1485. [PMID: 35103898 DOI: 10.1007/s10554-022-02541-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 01/25/2022] [Indexed: 11/05/2022]
Abstract
Previous reports suggested that poor pulmonary function was associated with increased arterial elastance (Ea) in patients with chronic obstructive pulmonary disease and systemic sclerosis. The mechanisms connecting pulmonary function and Ea have not yet been accurately studied in patients with idiopathic pulmonary fibrosis (IPF). The present study was designed to assess Ea in IPF patients without chronic severe pulmonary hypertension and to determine its prognostic role over a medium-term follow-up. This retrospective study included 60 consecutive patients with mild-to-moderate IPF (73.8 ± 6.6 years, 75% males) and 60 controls matched by age, sex and cardiovascular risk factors. All patients underwent physical examination, spirometry, blood tests, modified Haller index (MHI, chest transverse diameter over the distance between sternum and spine) assessment, conventional transthoracic echocardiography implemented with speckle tracking analysis of left atrial positive global strain (LA-GSA+ ) and finally carotid Doppler ultrasonography, at basal evaluation. The effective arterial elastance index (EaI) was calculated as the ratio of end-systolic pressure to stroke volume index. During follow-up period, we evaluated the composite endpoint of (1) pulmonary or cardiovascular hospitalizations; (2) all-cause mortality. At baseline, EaI was significantly higher in IPF patients than controls (4.1 ± 1.3 vs 3.5 ± 1.0 mmHg/ml/m2, p = 0.01). EaI was strongly correlated to the following variables: C-reactive protein (CRP) (r = 0.86), forced vital capacity (FVC) (r = - 0.91), E/e' ratio (r = 0.91), LA-GSA+ (r = - 0.92), common carotid artery-cross sectional area (CCA-CSA) (r = 0.89) and MHI (r = 0.86), in IPF patients. Mean follow-up time was 2.4 ± 1.3 years. During follow-up, 12 patients died and 17 were hospitalized due to major adverse clinical events. At univariate Cox analysis, CRP (HR 1.51, 95% CI 1.25-1.82), FVC (HR 0.88, 95% CI 0.85-0.91), LA-GSA+ (HR 0.85, 95% CI 0.77-0.94), CCA-CSA (HR 1.12, 95% CI 1.03-1.22) and EaI (HR 2.43, 95% CI 1.75-3.37) were significantly associated with outcome. At multivariate Cox analysis, only EaI (HR 1.60, 95% CI 1.03-2.50) retained statistical significance. An EaI ≥ 4 mmHg/ml/m2 showed 100% sensitivity and 99.4% specificity for predicting outcome (AUC = 0.98). In patients with mild-to-moderate IPF, an EaI ≥ 4 mmHg/ml/m2 is a negative prognostic factor over a medium-term follow-up.
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Affiliation(s)
- Andrea Sonaglioni
- Division of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
| | - Antonella Caminati
- Division of Pneumology, Semi-Intensive Care Unit, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy.
| | - Gian Luigi Nicolosi
- Division of Cardiology, Policlinico San Giorgio, Via Agostino Gemelli 10, 33170, Pordenone, Italy
| | - Michele Lombardo
- Division of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
| | - Sergio Harari
- Division of Pneumology, Semi-Intensive Care Unit, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Di Milano, Milan, Italy
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Chintala B, Duggal L, Jain N. Ascending aorta aneurysm in scleroderma. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2021; 6:322-326. [DOI: 10.1177/23971983211023322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/16/2021] [Indexed: 11/16/2022]
Abstract
Ascending aorta aneurysm in scleroderma can be ascribed to its macrovascular involvement which is very less elucidated. We here describe a 56-year-old female with rapidly progressive diffuse cutaneous scleroderma. She presented with skin thickening involving all four limbs, thorax and abdomen. She had other features like arthritis, Raynaud’s phenomena, dyspnoea, heaviness of chest, and dysphagia. On investigation, she was strongly positive for antinuclear antibody and Scl 70. Imaging revealed interstitial lung disease (nonspecific interstitial pneumonia pattern) and a fusiform dilatation of ascending aorta of 6.5 cm. Patient was offered surgical correction for aneurysm, for which she refused. To the best of our knowledge, our case report adds up to the few cases of ascending aorta aneurysm in scleroderma available in world literature.
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Affiliation(s)
- Bhavya Chintala
- Department of Rheumatology and clinical Immunology, Sir Ganga Ram Hospital, New Delhi, India
| | - Lalit Duggal
- Department of Rheumatology and clinical Immunology, Sir Ganga Ram Hospital, New Delhi, India
| | - Neeraj Jain
- Department of Rheumatology and clinical Immunology, Sir Ganga Ram Hospital, New Delhi, India
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Muhammad IF, Borné Y, Östling G, Kennbäck C, Gottsäter M, Persson M, Nilsson PM, Engström G. Acute phase proteins as prospective risk markers for arterial stiffness: The Malmö Diet and Cancer cohort. PLoS One 2017; 12:e0181718. [PMID: 28759613 PMCID: PMC5536304 DOI: 10.1371/journal.pone.0181718] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/06/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Arterial stiffness plays a significant role in the development and progression of adverse cardiovascular events and all-cause mortality. This observational study aims to explore the relationship between six acute phase proteins namely, ceruloplasmin, alpha-1-antitrypsin, orosomucoid, haptoglobin, complement C3 and C-reactive protein (CRP), and carotid-femoral pulse wave velocity (c-f PWV) in a population-based cohort, and to also explore the effect of low-grade inflammation on the relationship between diabetes and c-f PWV. METHOD The study consisted of participants from the Malmö Diet and Cancer study with data from baseline examinations (1991-1994) and follow-up examinations (2007-2012). Arterial stiffness was measured at follow-up by determining c-f PWV. After excluding participants with missing data, the total study population included 2338 subjects. General linear models were used to assess the relationship between baseline acute phase proteins and c-f PWV. RESULTS After adjusting for traditional risk factors the participants in the 4th quartile vs 1st quartile of alpha-1-antitrypsin (geometric mean: 10.32 m/s vs 10.04 m/s) (p<0.05), C3 (10.35 m/s vs 10.06 m/s) (p<0.05) and CRP (10.37 m/s vs 9.96 m/s) (p<0.001) showed significant association with c-f PWV. Diabetes at follow-up was also associated with high c-f PWV, however, this relationship was independent of low grade inflammation. CONCLUSION Alpha-1-antitrypsin, C3 and CRP are associated with arterial stiffness. The results indicate that low grade inflammation is associated with arterial stiffness in addition to established cardiovascular risk factors.
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Affiliation(s)
| | - Yan Borné
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Gerd Östling
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Skåne University Hospital, Malmö, Sweden
| | | | - Mikael Gottsäter
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Skåne University Hospital, Malmö, Sweden
| | - Margaretha Persson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Skåne University Hospital, Malmö, Sweden
| | - Peter M. Nilsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Skåne University Hospital, Malmö, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
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4
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Moeendarbary E, Weber IP, Sheridan GK, Koser DE, Soleman S, Haenzi B, Bradbury EJ, Fawcett J, Franze K. The soft mechanical signature of glial scars in the central nervous system. Nat Commun 2017; 8:14787. [PMID: 28317912 PMCID: PMC5364386 DOI: 10.1038/ncomms14787] [Citation(s) in RCA: 235] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 01/31/2017] [Indexed: 02/02/2023] Open
Abstract
Injury to the central nervous system (CNS) alters the molecular and cellular composition of neural tissue and leads to glial scarring, which inhibits the regrowth of damaged axons. Mammalian glial scars supposedly form a chemical and mechanical barrier to neuronal regeneration. While tremendous effort has been devoted to identifying molecular characteristics of the scar, very little is known about its mechanical properties. Here we characterize spatiotemporal changes of the elastic stiffness of the injured rat neocortex and spinal cord at 1.5 and three weeks post-injury using atomic force microscopy. In contrast to scars in other mammalian tissues, CNS tissue significantly softens after injury. Expression levels of glial intermediate filaments (GFAP, vimentin) and extracellular matrix components (laminin, collagen IV) correlate with tissue softening. As tissue stiffness is a regulator of neuronal growth, our results may help to understand why mammalian neurons do not regenerate after injury.
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Affiliation(s)
- Emad Moeendarbary
- Department of Physiology, Development and Neuroscience, University of Cambridge, Downing Street, Cambridge CB2 3DY, UK,Department of Biological Engineering, Massachusetts Institute of Technology, 77 Massachusetts Ave 56, Cambridge, Massachusetts 02139, USA,Department of Mechanical Engineering, University College London, London WC1E 7JE, UK,
| | - Isabell P. Weber
- Department of Physiology, Development and Neuroscience, University of Cambridge, Downing Street, Cambridge CB2 3DY, UK
| | - Graham K. Sheridan
- Department of Physiology, Development and Neuroscience, University of Cambridge, Downing Street, Cambridge CB2 3DY, UK,School of Pharmacy and Biomolecular Sciences, University of Brighton, Lewes Road, Brighton BN2 4GJ, UK
| | - David E. Koser
- Department of Physiology, Development and Neuroscience, University of Cambridge, Downing Street, Cambridge CB2 3DY, UK
| | - Sara Soleman
- John van Geest Centre for Brain Repair, University of Cambridge, Robinson Way, Cambridge CB2 0PY, UK
| | - Barbara Haenzi
- John van Geest Centre for Brain Repair, University of Cambridge, Robinson Way, Cambridge CB2 0PY, UK
| | - Elizabeth J. Bradbury
- Wolfson Centre for Age-Related Diseases, King's College London, Guy's Campus, London SE1 1UL, UK
| | - James Fawcett
- John van Geest Centre for Brain Repair, University of Cambridge, Robinson Way, Cambridge CB2 0PY, UK
| | - Kristian Franze
- Department of Physiology, Development and Neuroscience, University of Cambridge, Downing Street, Cambridge CB2 3DY, UK,
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Bitto A, Bagnato GL, Pizzino G, Roberts WN, Irrera N, Minutoli L, Russo G, Squadrito F, Saitta A, Bagnato GF, Altavilla D. Simvastatin prevents vascular complications in the chronic reactive oxygen species murine model of systemic sclerosis. Free Radic Res 2016; 50:514-22. [PMID: 26846205 DOI: 10.3109/10715762.2016.1149171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Aims Systemic sclerosis (SSc) is characterized by vasculopathy and organ fibrosis. Although microvascular alterations are very well characterized, structural and functional abnormalities of large vessels are not well defined. Therefore, we evaluated the effect of simvastatin administration on aortic and small renal arteries thickening, and on myofibroblasts differentiation in a murine model of SSc. Methods and results SSc was induced in BALB/c mice by daily subcutaneous injections of hypochlorous acid (HOCl, 100 μl) for 6 weeks. Mice (n = 23) were randomized to receive: HOCl (n = 10); HOCl plus simvastatin (40 mg/kg; n = 8); or vehicle (n = 5). Simvastatin administration started 30 min after HOCl injection, and up to week 6. Aortic and small renal arteries intima-media thickness was evaluated by histological analysis. Immunostaining for α-smooth muscle actin (SMA), vascular endothelial growth factor receptor 2 (VEGFR2), and CD31 in aortic tissues was performed to evaluate myofibroblast differentiation and endothelial markers.In HOCl-treated mice, intima-media thickening with reduced lumen diameter was observed in the aorta and in small renal arteries and simvastatin administration prevented this increase. Aortic and renal myofibroblasts count, as expressed by α-SMA + density, was lower in the group of mice treated with simvastatin compared to HOCl-treated mice. Simvastatin prevented the reduction in VEGFR2 and CD31 expression induced by HOCl. Conclusions The administration of simvastatin regulates collagen deposition in the aortic tissues and in the small renal arteries by modulating myofibroblasts differentiation and vascular markers. Further studies are needed to better address the effect of statins in the macrovascular component of SSc.
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Affiliation(s)
- Alessandra Bitto
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Gian Luca Bagnato
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Gabriele Pizzino
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | | | - Natasha Irrera
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Letteria Minutoli
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Giuseppina Russo
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Francesco Squadrito
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Antonino Saitta
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Gian Filippo Bagnato
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Domenica Altavilla
- c Department of Paediatric, Gynaecological, Microbiological and Biomedical Sciences , University of Messina , Messina , Italy
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Koseoglu C, Erdogan M, Ertem A, Koseoglu G, Akoglu G, Aktas A, Ozdemir E, Kurmus O, Durmaz T, Keles T, Bozkurt E. Aortic Elastic Properties and Myocardial Performance Index Are Impaired in Patients with Lichen Planus. Med Princ Pract 2016; 25:247-53. [PMID: 26683851 PMCID: PMC5588385 DOI: 10.1159/000443478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 12/17/2015] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the elastic properties of the aorta and the myocardial performance index of the left ventricle (LV) in patients with lichen planus (LP). SUBJECTS AND METHODS A total of 54 patients with LP and 50 controls were enrolled in the study. The 2 groups were well-matched regarding age, gender, body mass index, any smoking history, diabetes mellitus and systolic and diastolic blood pressure (SBP and DBP). The echocardiographic examination was performed on the study subjects and the controls. Aortic elasticity parameters and the myocardial performance index of the LV were calculated. The Student t test, the x03C7;2 test and multiple linear regression were used for the statistical analysis. RESULTS Aortic strain (AS, 4.77 ± 1.81 vs. 8.95 ± 2.22; p < 0.001) and aortic distensibility (AD, 0.25 ± 0.009 vs. 0.42 ± 0.120; p < 0.001) were significantly lower, and aortic stiffness index β (ASIβ, 3.65 ± 1.03 vs. 2.70 ± 0.91; p < 0.001) was significantly higher in the LP group than in the controls. The myocardial performance index (Tei index) was significantly higher in the LP group than in the control group (p = 0.001). The duration of the LP was negatively correlated with AS (r = -0.364, p < 0.001) and AD (r = -0.279, p = 0.006), and positively correlated with the Tei index (r = 0.324, p = 0.001) and ASIβ (r = 0.364, p < 0.001). After adjustment for relevant confounders (age, male gender, smoking, SBP, DBP, diabetes mellitus and low- and high-density lipoprotein cholesterol), LP and its duration were still associated with AS, AD and ASIβ. CONCLUSION In this study, AS and AD were lower and ASIβ and myocardial performance index higher in LP patients than in controls.
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Affiliation(s)
- C. Koseoglu
- Department of Cardiology, Ankara Training and Research Hospital, Departments of, Mersin, Turkey
- *Cemal Koseoglu, MD, Ankara Training and Research Hospital, Sukriye District, Ulucanlar Street, TR-06340 Altýndag, Ankara (Turkey), E-Mail
| | - M. Erdogan
- Department of Cardiology, Tarsus State Hospital, Cardiology, Mersin, Turkey
| | - A.G. Ertem
- Department of Cardiology, Tarsus State Hospital, Cardiology, Mersin, Turkey
| | - G. Koseoglu
- Department of Dermatology, Ankara University Faculty of Medicine, Ankara, Mersin, Turkey
| | - G. Akoglu
- Dermatology of Ataturk Training and Research Hospital, Mersin, Turkey
| | - A. Aktas
- Dermatology of Ataturk Training and Research Hospital, Mersin, Turkey
| | - E. Ozdemir
- Department of Cardiology, Tarsus State Hospital, Cardiology, Mersin, Turkey
| | - O. Kurmus
- Department of Cardiology, Tarsus State Hospital, Mersin, Turkey
| | - T. Durmaz
- Department of Cardiology, Tarsus State Hospital, Cardiology, Mersin, Turkey
| | - T. Keles
- Department of Cardiology, Tarsus State Hospital, Cardiology, Mersin, Turkey
| | - E. Bozkurt
- Department of Cardiology, Tarsus State Hospital, Cardiology, Mersin, Turkey
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Aissopou EK, Bournia VK, Protogerou AD, Panopoulos S, Papaioannou TG, Vlachoyiannopoulos PG, Matucci-Cerinic M, Sfikakis PP. Intact calibers of retinal vessels in patients with systemic sclerosis. J Rheumatol 2015; 42:608-13. [PMID: 25641886 DOI: 10.3899/jrheum.141425] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A primary endothelial cell dysfunction is thought to be involved in systemic sclerosis (SSc)-associated fibroproliferative vasculopathy of the microcirculation and small arterioles, even in sites not affected by fibrosis. Because the role of fibroblasts in pathologic modifications and vascular wall remodeling is relatively unclear, and because the retina provides a unique opportunity to assess microcirculation in the absence of resident fibroblasts, we systematically evaluated retinal vessels in patients with SSc. METHODS Digital retinal images were obtained from both eyes of 93 consecutive patients with fully characterized SSc and 29 healthy controls matched 1:1 for age and sex with selected patients without diabetes, hypertension history, or antihypertensive treatment. Internal microvascular calibers (erythrocyte column width in μm) by central retinal arteriolar and venular equivalents and arteriolar to venular ratio were measured using validated software. RESULTS Arteriolar and venular calibers were similar in patients and their matched controls (mean ± SEM; 187 ± 2 vs 184 ± 3, p = 0.444, and 211 ± 2 vs 216 ± 3, p = 0.314, respectively). Both arteriolar and venular calibers and their ratio in patients with SSc were not associated with disease duration, extent of skin involvement, pulmonary fibrosis, digital ulcers or pitting scars, amputations, digital capillaroscopic findings, inflammatory indices, or autoantibodies. CONCLUSION The evidence that retinal microcirculation is spared in SSc suggests that fibroproliferative vasculopathy may depend on specific cellular or soluble factors not present in the retinal environment.
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Affiliation(s)
- Evaggelia K Aissopou
- From the Rheumatology Unit, First Department of Propedeutic and Internal Medicine, and the Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece; Department of Clinical and Experimental Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi (AOUC), University of Florence, Florence, Italy.E.K. Aissopou, MD; V-K. Bournia, MD; A.D. Protogerou, MD, PhD; S. Panopoulos, MD, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; T.G. Papaioannou, PhD, Assistant Professor in Biomedical Engineering, Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School; P.G. Vlachoyiannopoulos, MD, PhD, Professor of Medicine-Immunology, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; M. Matucci-Cerinic, MD, PhD, Professor of Rheumatology, Department of Clinical and Experimental Medicine, Division of Rheumatology, AOUC, University of Florence; P.P. Sfikakis, MD, PhD, Professor of Internal Medicine, Head of Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School.
| | - Vasiliki-Kalliopi Bournia
- From the Rheumatology Unit, First Department of Propedeutic and Internal Medicine, and the Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece; Department of Clinical and Experimental Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi (AOUC), University of Florence, Florence, Italy.E.K. Aissopou, MD; V-K. Bournia, MD; A.D. Protogerou, MD, PhD; S. Panopoulos, MD, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; T.G. Papaioannou, PhD, Assistant Professor in Biomedical Engineering, Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School; P.G. Vlachoyiannopoulos, MD, PhD, Professor of Medicine-Immunology, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; M. Matucci-Cerinic, MD, PhD, Professor of Rheumatology, Department of Clinical and Experimental Medicine, Division of Rheumatology, AOUC, University of Florence; P.P. Sfikakis, MD, PhD, Professor of Internal Medicine, Head of Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School
| | - Athanase D Protogerou
- From the Rheumatology Unit, First Department of Propedeutic and Internal Medicine, and the Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece; Department of Clinical and Experimental Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi (AOUC), University of Florence, Florence, Italy.E.K. Aissopou, MD; V-K. Bournia, MD; A.D. Protogerou, MD, PhD; S. Panopoulos, MD, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; T.G. Papaioannou, PhD, Assistant Professor in Biomedical Engineering, Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School; P.G. Vlachoyiannopoulos, MD, PhD, Professor of Medicine-Immunology, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; M. Matucci-Cerinic, MD, PhD, Professor of Rheumatology, Department of Clinical and Experimental Medicine, Division of Rheumatology, AOUC, University of Florence; P.P. Sfikakis, MD, PhD, Professor of Internal Medicine, Head of Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School
| | - Stylianos Panopoulos
- From the Rheumatology Unit, First Department of Propedeutic and Internal Medicine, and the Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece; Department of Clinical and Experimental Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi (AOUC), University of Florence, Florence, Italy.E.K. Aissopou, MD; V-K. Bournia, MD; A.D. Protogerou, MD, PhD; S. Panopoulos, MD, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; T.G. Papaioannou, PhD, Assistant Professor in Biomedical Engineering, Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School; P.G. Vlachoyiannopoulos, MD, PhD, Professor of Medicine-Immunology, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; M. Matucci-Cerinic, MD, PhD, Professor of Rheumatology, Department of Clinical and Experimental Medicine, Division of Rheumatology, AOUC, University of Florence; P.P. Sfikakis, MD, PhD, Professor of Internal Medicine, Head of Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School
| | - Theodoros G Papaioannou
- From the Rheumatology Unit, First Department of Propedeutic and Internal Medicine, and the Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece; Department of Clinical and Experimental Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi (AOUC), University of Florence, Florence, Italy.E.K. Aissopou, MD; V-K. Bournia, MD; A.D. Protogerou, MD, PhD; S. Panopoulos, MD, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; T.G. Papaioannou, PhD, Assistant Professor in Biomedical Engineering, Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School; P.G. Vlachoyiannopoulos, MD, PhD, Professor of Medicine-Immunology, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; M. Matucci-Cerinic, MD, PhD, Professor of Rheumatology, Department of Clinical and Experimental Medicine, Division of Rheumatology, AOUC, University of Florence; P.P. Sfikakis, MD, PhD, Professor of Internal Medicine, Head of Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School
| | - Panayiotis G Vlachoyiannopoulos
- From the Rheumatology Unit, First Department of Propedeutic and Internal Medicine, and the Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece; Department of Clinical and Experimental Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi (AOUC), University of Florence, Florence, Italy.E.K. Aissopou, MD; V-K. Bournia, MD; A.D. Protogerou, MD, PhD; S. Panopoulos, MD, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; T.G. Papaioannou, PhD, Assistant Professor in Biomedical Engineering, Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School; P.G. Vlachoyiannopoulos, MD, PhD, Professor of Medicine-Immunology, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; M. Matucci-Cerinic, MD, PhD, Professor of Rheumatology, Department of Clinical and Experimental Medicine, Division of Rheumatology, AOUC, University of Florence; P.P. Sfikakis, MD, PhD, Professor of Internal Medicine, Head of Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School
| | - Marco Matucci-Cerinic
- From the Rheumatology Unit, First Department of Propedeutic and Internal Medicine, and the Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece; Department of Clinical and Experimental Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi (AOUC), University of Florence, Florence, Italy.E.K. Aissopou, MD; V-K. Bournia, MD; A.D. Protogerou, MD, PhD; S. Panopoulos, MD, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; T.G. Papaioannou, PhD, Assistant Professor in Biomedical Engineering, Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School; P.G. Vlachoyiannopoulos, MD, PhD, Professor of Medicine-Immunology, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; M. Matucci-Cerinic, MD, PhD, Professor of Rheumatology, Department of Clinical and Experimental Medicine, Division of Rheumatology, AOUC, University of Florence; P.P. Sfikakis, MD, PhD, Professor of Internal Medicine, Head of Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School
| | - Petros P Sfikakis
- From the Rheumatology Unit, First Department of Propedeutic and Internal Medicine, and the Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece; Department of Clinical and Experimental Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi (AOUC), University of Florence, Florence, Italy.E.K. Aissopou, MD; V-K. Bournia, MD; A.D. Protogerou, MD, PhD; S. Panopoulos, MD, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; T.G. Papaioannou, PhD, Assistant Professor in Biomedical Engineering, Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School; P.G. Vlachoyiannopoulos, MD, PhD, Professor of Medicine-Immunology, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; M. Matucci-Cerinic, MD, PhD, Professor of Rheumatology, Department of Clinical and Experimental Medicine, Division of Rheumatology, AOUC, University of Florence; P.P. Sfikakis, MD, PhD, Professor of Internal Medicine, Head of Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School
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8
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Tedford RJ, Mudd JO, Girgis RE, Mathai SC, Zaiman AL, Housten-Harris T, Boyce D, Kelemen BW, Bacher AC, Shah AA, Hummers LK, Wigley FM, Russell SD, Saggar R, Saggar R, Maughan WL, Hassoun PM, Kass DA. Right ventricular dysfunction in systemic sclerosis-associated pulmonary arterial hypertension. Circ Heart Fail 2013; 6:953-63. [PMID: 23797369 DOI: 10.1161/circheartfailure.112.000008] [Citation(s) in RCA: 182] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Systemic sclerosis–associated pulmonary artery hypertension (SScPAH) has a worse prognosis compared with idiopathic pulmonary arterial hypertension (IPAH), with a median survival of 3 years after diagnosis often caused by right ventricular (RV) failure. We tested whether SScPAH or systemic sclerosis–related pulmonary hypertension with interstitial lung disease imposes a greater pulmonary vascular load than IPAH and leads to worse RV contractile function. METHODS AND RESULTS We analyzed pulmonary artery pressures and mean flow in 282 patients with pulmonary hypertension (166 SScPAH, 49 systemic sclerosis–related pulmonary hypertension with interstitial lung disease, and 67 IPAH). An inverse relation between pulmonary resistance and compliance was similar for all 3 groups, with a near constant resistance×compliance product. RV pressure–volume loops were measured in a subset, IPAH (n=5) and SScPAH (n=7), as well as SSc without PH (n=7) to derive contractile indexes (end-systolic elastance [Ees] and preload recruitable stroke work [Msw]), measures of RV load (arterial elastance [Ea]), and RV pulmonary artery coupling (Ees/Ea). RV afterload was similar in SScPAH and IPAH (pulmonary vascular resistance=7.0±4.5 versus 7.9±4.3 Wood units; Ea=0.9±0.4 versus 1.2±0.5 mm Hg/mL; pulmonary arterial compliance=2.4±1.5 versus 1.7±1.1 mL/mm Hg; P>0.3 for each). Although SScPAH did not have greater vascular stiffening compared with IPAH, RV contractility was more depressed (Ees=0.8±0.3 versus 2.3±1.1, P<0.01; Msw=21±11 versus 45±16, P=0.01), with differential RV-PA uncoupling (Ees/Ea=1.0±0.5 versus 2.1±1.0; P=0.03). This ratio was higher in SSc without PH (Ees/Ea=2.3±1.2; P=0.02 versus SScPAH). CONCLUSIONS RV dysfunction is worse in SScPAH compared with IPAH at similar afterload, and may be because of intrinsic systolic function rather than enhanced pulmonary vascular resistive and pulsatile loading.
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MESH Headings
- Adult
- Aged
- Analysis of Variance
- Arterial Pressure
- Cardiac Catheterization
- Chi-Square Distribution
- Compliance
- Familial Primary Pulmonary Hypertension
- Female
- Humans
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/physiopathology
- Linear Models
- Lung Diseases, Interstitial/etiology
- Lung Diseases, Interstitial/physiopathology
- Male
- Middle Aged
- Myocardial Contraction
- Nonlinear Dynamics
- Predictive Value of Tests
- Prognosis
- Pulmonary Artery/physiopathology
- Pulmonary Circulation
- Risk Factors
- Scleroderma, Systemic/complications
- United States
- Vascular Resistance
- Ventricular Dysfunction, Right/diagnosis
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Right
- Ventricular Pressure
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9
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Kasdi R, El Arid JM, Lambert M, Launay D, Polge AS, Koussa M, Modine T. To spare or not to spare…? The aortic valve in scleroderma and aortic root aneurysm. J Card Surg 2013; 29:55-8. [PMID: 24224770 DOI: 10.1111/jocs.12239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Acute valve-sparing procedures are effective in the treatment of aortic root dilation when there is no valve pathology. In this review, we discuss the role of aortic valve-sparing procedures in the presence of connective tissue disorders such as scleroderma.
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Affiliation(s)
- Reda Kasdi
- Faculty of Medicine, Cardiovascular Surgery Department, Cardiologic Hospital, Lille Nord de France University, CHRU Lille, France
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10
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Owlia MB, Mostafavi Pour Manshadi SMY, Naderi N. Cardiac manifestations of rheumatological conditions: a narrative review. ISRN RHEUMATOLOGY 2012; 2012:463620. [PMID: 23119182 PMCID: PMC3483730 DOI: 10.5402/2012/463620] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 09/21/2012] [Indexed: 01/08/2023]
Abstract
Cardiovascular diseases are common in systemic rheumatologic diseases. They can be presented at the time of diagnosis or after diagnosis. The cardiac involvements can be the first presentation of rheumatologic conditions. It means that a patient with rheumatologic disease may go to a cardiologist when attacked by this disease at first. These manifestations are very different and involve different structures of the heart, and they can cause mortality and morbidity of patients with rheumatologic diseases. Cardiac involvements in these patients vary from subclinical to severe manifestations. They may need aggressive immunosuppressive therapy. The diagnosis of these conditions is very important for choosing the best treatment. Premature atherosclerosis and ischemic heart disease are increased in rheumatoid arthritis and systemic lupus erythematosus, and may be causes of mortality among them. The aggressive control of systemic inflammation in these diseases can reduce the risk of cardiovascular disease especially ischemic heart disease. Although aggressive treatment of primary rheumatologic diseases can decrease mortality rate and improve them, at this time, there are no specific guidelines and recommendations, to include aggressive control and prevention of traditional risk factors, for them.
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Affiliation(s)
- Mohammad Bagher Owlia
- Department of Medicine, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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11
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Zormpala A, Sipsas NV, Moyssakis I, Georgiadou SP, Gamaletsou MN, Kontos AN, Ziakas PD, Kordossis T. Impaired distensibility of ascending aorta in patients with HIV infection. BMC Infect Dis 2012; 12:167. [PMID: 22846182 PMCID: PMC3447671 DOI: 10.1186/1471-2334-12-167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 06/21/2012] [Indexed: 11/17/2022] Open
Abstract
Background Our aim was to investigate the aortic distensibility (AD) of the ascending aorta and carotid artery intima-media thickness (c-IMT) in HIV-infected patients compared to healthy controls. Methods One hundred and five HIV-infected patients (86 males [82%], mean age 41 ± 0.92 years), and 124 age and sex matched HIV-1 uninfected controls (104 males [84%], mean age 39.2 ± 1.03 years) were evaluated by high-resolution ultrasonography to determine AD and c-IMT. For all patients and controls clinical and laboratory factors associated with atherosclerosis were recorded. Results HIV- infected patients had reduced AD compared to controls: 2.2 ± 0.01 vs. 2.62 ± 0.01 10-6 cm2 dyn-1, respectively (p < 0.001). No difference was found in c-IMT between the two groups. In multiadjusted analysis, HIV infection was independently associated with decreased distensibility (beta –0.45, p < 0.001). Analysis among HIV-infected patients showed that patients exposed to HAART had decreased AD compared to HAART-naïve patients [mean (SD): 2.18(0.02) vs. 2.28(0.03) 10-6 cm2 dyn-1, p = 0.01]. In multiadjusted analysis, increasing age and exposure to HAART were independently associated with decreased AD. Conclusion HIV infection is independently associated with decreased distensibility of the ascending aorta, a marker of subclinical atherosclerosis. Increasing age and duration of exposure to HAART are factors further contributing to decreased AD.
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Affiliation(s)
- Alexandra Zormpala
- Radiology Department, Laikon General Hospital of Athens, Medical School, National and Kapodistrian University, Mikras Asias 75, 11527 Athens, Greece
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12
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Villa-Forte A, Mandell BF. [Cardiovascular disorders and rheumatic disease]. Rev Esp Cardiol 2011; 64:809-17. [PMID: 21763053 DOI: 10.1016/j.recesp.2011.05.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 05/25/2011] [Indexed: 01/01/2023]
Abstract
Cardiovascular disease is a common and under-recognized problem in patients with systemic rheumatic conditions. Patients may present with disease associated heart involvement at the time of diagnosis or later in the course of the illness. The manifestations vary by disease, and all structures in the heart can be affected and may result in significant morbidity and mortality. Manifestations of cardiac disease in these patients range from subclinical to severe and may require aggressive immunosuppressive therapy. Early recognition is important for prompt institution of appropriate therapy. Treatment of disease associated cardiac involvement is based on severity of disease with more severe manifestations often requiring a combination of corticosteroid and cytotoxic agent. Premature atherosclerosis has been increasingly recognized in patients with systemic lupus erythematosus and rheumatoid arthritis and may result in premature coronary death when compared to the general population. Aggressive control of systemic inflammation in these diseases may result in a reduction in the risk of ischemic heart disease. Although aggressive treatment of the primary rheumatic disease has been associated with an improvement in mortality rates, specific guidelines for prevention of ischemic heart disease in this group of patients have not been formulated and recommendations at this time include aggressive control and monitoring of traditional risk factors.
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Affiliation(s)
- Alexandra Villa-Forte
- Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio, USA.
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13
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Cusmà Piccione M, Bagnato G, Zito C, Di Bella G, Caliri A, Catalano M, Longordo C, Oreto G, Bagnato G, Carerj S. Early Identification of Vascular Damage in Patients With Systemic Sclerosis. Angiology 2011; 62:338-43. [DOI: 10.1177/0003319710387918] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Vascular involvement in systemic sclerosis (SSc) plays a key role in the pathogenesis of fibrosis. We assessed arterial stiffness using a new echo-tracking technique in patients with SSc asymptomatic for cardiovascular diseases. We enrolled 22 patients (21 female, 63 ± 14 years) and 20 controls (12 female, 62 ± 3 years). Carotid intima-media thickness (IMT) was comparable between the 2 groups (1.1 ± 0.3 vs 1.0 ± 0.4 mm, P = ns), whereas the stiffness parameters were significantly increased in patients (β: 9.5 ± 4.2 vs 5.8 ± 1.1, P = .001; pulse wave velocity [PWV]: 6.5 ± 1.5 vs 5.2 ± 0.6 m/sec, P = .003). A correlation between stiffness parameters, anti-Scl-70 antibodies (β: r = .46, P = .03; PWV: r = .50, P = .02), and anticentromere antibodies (β: r = -.54, P = .020; PWV: r = -.53, P = .023) was found. Echo-tracking technique may be valuable in early identification of vascular involvement in patients with SSc.
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Affiliation(s)
| | - Gianluca Bagnato
- Department of Medicine and Pharmacology, Cardiology, University of Messina, Italy
| | - Concetta Zito
- Department of Medicine and Pharmacology, Cardiology, University of Messina, Italy
| | - Gianluca Di Bella
- Department of Medicine and Pharmacology, Cardiology, University of Messina, Italy
| | - Annalisa Caliri
- Department of Medicine and Pharmacology, Cardiology, University of Messina, Italy
| | - Mariarita Catalano
- Department of Medicine and Pharmacology, Cardiology, University of Messina, Italy
| | - Caterina Longordo
- Department of Medicine and Pharmacology, Cardiology, University of Messina, Italy
| | - Giuseppe Oreto
- Department of Medicine and Pharmacology, Cardiology, University of Messina, Italy
| | - Gianfilippo Bagnato
- Department of Medicine and Pharmacology, Cardiology, University of Messina, Italy
| | - Scipione Carerj
- Department of Medicine and Pharmacology, Cardiology, University of Messina, Italy
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14
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Soltész P, Kerekes G, Dér H, Szücs G, Szántó S, Kiss E, Bodolay E, Zeher M, Timár O, Szodoray P, Szegedi G, Szekanecz Z. Comparative assessment of vascular function in autoimmune rheumatic diseases: considerations of prevention and treatment. Autoimmun Rev 2011; 10:416-25. [PMID: 21281743 DOI: 10.1016/j.autrev.2011.01.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Accepted: 01/08/2011] [Indexed: 12/31/2022]
Abstract
Numerous autoimmune-inflammatory rheumatic diseases have been associated with accelerated atherosclerosis or other types of vasculopathy leading to increased cardio- and cerebrovascular disease risk. Traditional risk factors, as well as the role of systemic inflammation including cytokines, chemokines, proteases, autoantibodies, adhesion receptors and others have been implicated in the development of these vascular pathologies. The characteristics of vasculopathies may significantly differ depending on the underlying disease. While classical accelerated atherosclerosis has been associated with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) or spondyloarthropathies (SpA), obliterative vasculopathy may rather be characteristic for systemic sclerosis (SSc) or mixed connective tissue disease (MCTD). Antiphospholipid antibodies have been implicated in vasculopathies underlying SLE, antiphospholipid syndrome (APS), RA and MCTD. There is also heterogeneity with respect to inflammatory risk factors. Cytokines, such as tumor necrosis factor-α (TNF-α) or interleukin 6 (IL-6) and immune complexes are primarily involved in arthritides, such as RA, SpA, as well as in SLE. On the other hand, autoantibodies including anti-oxLDL anti-cardiolipin and anti-β2GPI are rather involved in SLE- and APS-associated vasculopathies. Regarding the non-invasive assessment of vascular function, endothelial dysfunction, overt atherosclerosis and vascular stiffness may be indicated by brachial artery flow-mediated vasodilation (FMD), common carotid intima-media thickness (ccIMT) and aortic pulse-wave velocity (PWV), respectively. These abnormalities have been described in most inflammatory rheumatic diseases. While ccIMT and stiffness are relatively stable, FMD may be influenced by many confounding factors. In addition to traditional vasculoprotection, immunosuppressive agents including corticosteroids, traditional and biologic DMARDs may have significant vascular and metabolic effects. The official EULAR recommendations on the assessment and management of cardiovascular disease in arthritides have just been published, and similar recommendations in connective tissue diseases are to be developed soon.
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Affiliation(s)
- Pál Soltész
- University of Debrecen Medical and Health Sciences Center, Institute of Medicine, Third Department of Medicine, Angiology and Intensive Care Unit, Debrecen, Hungary
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15
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Grattagliano V, Iannone F, Praino E, De Zio A, Riccardi MT, Carrozzo N, Covelli M, Maggi P, Lapadula G. Digital laser doppler flowmetry may discriminate “limited” from “diffuse” systemic sclerosis. Microvasc Res 2010; 80:221-6. [DOI: 10.1016/j.mvr.2010.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 04/11/2010] [Accepted: 04/14/2010] [Indexed: 10/19/2022]
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16
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Rossi P, Granel B, Marziale D, Le Mée F, Francès Y. Endothelial function and hemodynamics in systemic sclerosis. Clin Physiol Funct Imaging 2010; 30:453-9. [PMID: 20718808 DOI: 10.1111/j.1475-097x.2010.00965.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Systemic sclerosis (SSc) is characterized by the development of fibrosis of skin and internal organs that is associated with vascular damage. However, its related parameters have not been fully explored. The aim of this study was to investigate endothelial function in SSc and its relationship with systolic pulmonary artery pressure and systemic arterial compliance (SAC). METHODS We studied 14 SSc females (4 with diffuse and 10 with limited cutaneous form of the disease) and 14 healthy controls matched for age and for cardiovascular risk factors. Endothelium-dependent dilation (i.e. flow-mediated) and endothelium-independent (i.e. nitroglycerin-induced) dilation of the brachial artery were measured as the percentage of change from baseline (FMD and NMD, respectively). In patients with SSc, SAC, cardiac output (CO), systemic arterial resistance and pulmonary artery pressure were estimated using echocardiography Doppler. RESULTS Heart rate, brachial artery pressure and body mass index did not differ between patients with SSc and controls. Flow-mediated vasodilation (FMD) and NMD were significantly decreased in patients with SSc (10.3 ± 8.6 versus 26.6 ± 7.4%, P<0.001; 24.2 ± 8.4 versus 33.3 ± 10.1%, P<0.001, respectively). Postischaemia reactive hyperaemia was lower in patients with SSc (275 ± 185 versus 618 ± 366%, P<0.001). FMD and nitrate-mediated dilation (NMD) were associated with CO, but not with SAC; moreover, FMD correlated with pulmonary artery pressure and peripheral arterial resistance conversely to NMD. CONCLUSIONS Endothelium function in SSc is impaired independently to SAC. Furthermore, the severity of both small artery and pulmonary artery involvement may impact on endothelium-dependent function.
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Affiliation(s)
- Pascal Rossi
- Internal Medicine department, North Hospital, Chemin des Bourrely, Marseille Cedex, France.
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17
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Derrett-Smith EC, Dooley A, Khan K, Shi-wen X, Abraham D, Denton CP. Systemic vasculopathy with altered vasoreactivity in a transgenic mouse model of scleroderma. Arthritis Res Ther 2010; 12:R69. [PMID: 20398328 PMCID: PMC2888224 DOI: 10.1186/ar2986] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 01/14/2010] [Accepted: 04/15/2010] [Indexed: 01/25/2023] Open
Abstract
Introduction Vasculopathy, including altered vasoreactivity and abnormal large vessel biomechanics, is a hallmark of systemic sclerosis (SSc). However, the pathogenic link with other aspects of the disease is less clear. To assess the potential role of transforming growth factor beta (TGF-β) overactivity in driving these cardiovascular abnormalities, we studied a novel transgenic mouse model characterized by ligand-dependent activation of TGF-β signaling in fibroblasts. Methods The transgenic mouse strain Tβ RIIΔk-fib is characterized by balanced ligand-dependent upregulation of TGF-β signaling. Aortic and cardiac tissues were examined with histologic, biochemical, and isolated organ bath studies. Vascular and perivascular architecture was examined by hematoxylin and eosin (H&E) and special stains including immunostaining for TGF-β1 and phospho-Smad2/3 (pSmad2/3). Confirmatory aortic smooth muscle cell proliferation, phenotype, and functional assays, including signaling responses to exogenous TGF-β and endothelin-1, were performed. Aortic ring contractile responses to direct and receptor-mediated stimulation were assessed. Results Aortic ring contractility and relaxation were diminished compared with wild-type controls, and this was associated with aortic adventitial fibrosis confirmed histologically and with Sircol assay. TGF-β1 and pSmad 2/3 expression was increased in the adventitia and smooth muscle layer of the aorta. Aortic smooth muscle cells from transgenic animals showed significant upregulation of TGF-β- responsive genes important for cytoskeletal function, such as transgelin and smoothelin, which were then resistant to further stimulation with exogenous TGF-β1. These cells promoted significantly more contraction of free floating type I collagen lattices when compared with the wild-type, but were again resistant to exogenous TGF-β1 stimulation. Aortic ring responses to receptor-mediated contraction were reduced in the transgenic animals. Specifically, bosentan reduced endothelin-mediated contraction in wild-type animals, but had no effect in transgenic animals, and endothelin axis gene expression was altered in transgenic animals. Transgenic mice developed cardiac fibrosis. Conclusions The histologic, biochemical, and functional phenotype of this transgenic mouse model of scleroderma offers insight into the altered biomechanical properties previously reported for large elastic arteries in human SSc and suggests a role for perturbed TGF-β and endothelin activity in this process.
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Affiliation(s)
- Emma C Derrett-Smith
- Centre for Rheumatology and Connective Tissue Diseases, UCL Medical School, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
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18
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Moyssakis I, Gialafos E, Vassiliou VA, Boki K, Votteas V, Sfikakis PP, Tzelepis GE. Myocardial performance and aortic elasticity are impaired in patients with ankylosing spondylitis. Scand J Rheumatol 2009; 38:216-21. [PMID: 19229673 DOI: 10.1080/03009740802474672] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To measure aortic stiffness and global left ventricular (LV) function in patients with ankylosing spondylitis (AS) and no clinical evidence of heart disease. METHODS Fifty-seven consecutive patients with AS (54 males, three females, mean age 41.78+/-10.02 years) without clinical evidence of cardiac involvement and 78 healthy subjects (73 males, five females, mean age 39.92+/-9.11 years) underwent complete echocardiographic study. Aortic stiffness was determined non-invasively by aortic distensibility (AoD) and the global LV function was evaluated by the myocardial performance index (the Tei index). RESULTS AoD in patients with AS [(2.21+/-0.24)x10(-6) cm(2) dyn(-1)] was decreased compared to controls [(2.58+/-0.19) )x10(-6) cm(2) dyn(-1), p<0.01], confirming that aortic stiffness is increased in AS. The LV Tei index was significantly increased in the patient group compared to the control group (0.392+/-0.031 vs. 0.370+/-0.034, p<0.01). The ejection fraction (EF) did not differ between the two groups (p>0.05). In multivariate linear regression analysis, AoD was significantly associated with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and LV isovolumic relaxation time (IVRT) whereas the LV Tei index was associated with BASDAI and the LV mass index. CONCLUSIONS Patients with AS and no clinical evidence of cardiac disease have increased stiffness of the aorta and decreased global myocardial performance and both of these abnormal measurements correlate with disease activity. The abnormal Tei index may reflect an early manifestation of cardiac dysfunction in these patients.
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Affiliation(s)
- I Moyssakis
- Cardiology Department, Laiko General Hospital, Athens, Greece.
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19
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Peled N, Shitrit D, Fox BD, Shlomi D, Amital A, Bendayan D, Kramer MR. Peripheral arterial stiffness and endothelial dysfunction in idiopathic and scleroderma associated pulmonary arterial hypertension. J Rheumatol 2009; 36:970-5. [PMID: 19369472 DOI: 10.3899/jrheum.081088] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Pulmonary endothelial dysfunction and increased reflection of pulmonary pressure waves have been reported in pulmonary arterial hypertension (PAH). However, the systemic vascular involvement is not fully understood. Our study focused on the systemic arterial stiffness and endothelial involvement in idiopathic and scleroderma associated PAH. METHODS Peripheral arterial stiffness and endothelial function were evaluated in 38 patients with idiopathic (n = 28) and scleroderma associated (n = 10) PAH, and 21 control subjects (13 healthy; 8 with scleroderma and normal pulmonary pressure). All participants underwent clinical and cardiopulmonary evaluation. Arterial stiffness was measured through the fingertip tonometry derived augmentation index (AI), which is the boost increase in the late systolic pressure wave after the initial systolic shoulder. Endothelial function was measured by forearm blood flow dilatation response to brachial artery occlusion by a noninvasive plethysmograph (EndoPAT 2000), which is associated with nitric oxide-dependent vasodilatation and yields a peripheral arterial tone (PAT) ratio. RESULTS Mean systolic pulmonary pressure was 70.5 +/- 21.6 mm Hg (idiopathic-PAH) and 69.3 +/- 20 mm Hg (scleroderma-PAH). AI was higher in scleroderma patients (10.5% +/- 19.6% in healthy controls, 9.0% +/- 21.5% in idiopathic-PAH, 20.1% +/- 19.1% in scleroderma-PAH, and 24.4% +/- 18.9% in scleroderma-controls; nonsignificant). PAT ratio was significantly lower (p < 0.05) than control values in idiopathic-PAH and scleroderma-PAH (PAT ratio: control 2.20 +/- 0.25; idiopathic 1.84 +/- 0.51; scleroderma 1.66 +/- 0.66). AI was not correlated to endothelial dysfunction. There were no differences between the 2 PAH patient groups in age, body mass index, New York Heart Association classification, or 6-min walk test. CONCLUSION Our study shows a trend towards increased arterial stiffness in scleroderma (nonsignificant), and also peripheral endothelial dysfunction in idiopathic-PAH and in scleroderma-PAH. These findings suggest involvement of different vessels in scleroderma-PAH compared to idiopathic-PAH.
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Affiliation(s)
- Nir Peled
- Pulmonary Institute, Rabin Medical Center, Petah Tiqwa, Israel.
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Shehata ML, Singh S, Lima JAC, Hassoun P, Bluemke DA, Vogel-Claussen J. Pulmonary distensibility and flow dynamics in systemic sclerosis using velocity encoded magnetic resonance imaging. J Cardiovasc Magn Reson 2009. [PMCID: PMC7853776 DOI: 10.1186/1532-429x-11-s1-p170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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21
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Gialafos EJ, Moyssakis I, Psaltopoulou T, Papadopoulos DP, Perea D, Vlasis K, Kostopoulos C, Votteas V, Sfikakis PP. Circulating tissue inhibitor of matrix metalloproteinase-4 (TIMP-4) in systemic sclerosis patients with elevated pulmonary arterial pressure. Mediators Inflamm 2009; 2008:164134. [PMID: 19190762 PMCID: PMC2630404 DOI: 10.1155/2008/164134] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2008] [Revised: 10/14/2008] [Accepted: 10/28/2008] [Indexed: 11/17/2022] Open
Abstract
Decreased levels of matrix metalloproteinases (MMPs) or excess levels of their tissue inhibitors (TIMPs) may contribute to dysregulation of extracellular matrix turnover in systemic sclerosis (SSc). In a cross-sectional study of 106 SSc patients, we measured serum levels of TIMP-4 which is preferentially expressed in cardiovascular structures and searched for correlations with simultaneously performed echocardiography measurements of pulmonary artery systolic pressure (PASP), myocardial performance, and pulmonary function tests. TIMP-4, but not MMP-9, levels were significantly raised in patients with SSc than controls. However, in the subgroup of patients with PASP measurements lower to 40 mmHg (n = 69), TIMP-4 levels were comparable to controls irrespective of the presence of diffuse or limited skin involvement, or lung fibrosis. Individual PASP measurements suggestive of pulmonary hypertension were associated with increased TIMP-4 serum levels (P = .03), independently of age, extent of skin sclerosis, or lung fibrosis, suggesting a cardiopulmonary vasculature-specific role of TIMP-4 activation in SSc.
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Affiliation(s)
- Elias J. Gialafos
- Cardiology Department, Laikon General Hospital, University of Athens Medical School, 115 27 Athens, Greece
- First Department of Propaedeutic and Internal Medicine, University of Athens Medical School, 115 27 Athens, Greece
| | - Ioannis Moyssakis
- Cardiology Department, Laikon General Hospital, University of Athens Medical School, 115 27 Athens, Greece
| | - Theodora Psaltopoulou
- Department of Hygiene and Epidemiology, University of Athens Medical School, 115 27 Athens, Greece
| | - Dimitrios P. Papadopoulos
- Cardiology Department, Laikon General Hospital, University of Athens Medical School, 115 27 Athens, Greece
| | - Despoina Perea
- First Department of Propaedeutic and Internal Medicine, University of Athens Medical School, 115 27 Athens, Greece
| | - Kostantinos Vlasis
- First Department of Propaedeutic and Internal Medicine, University of Athens Medical School, 115 27 Athens, Greece
| | - Charalampos Kostopoulos
- Pulmonary Unit, Department of Therapeutics, University of Athens Medical School, 115 27 Athens, Greece
| | - Vassilios Votteas
- Cardiology Department, Laikon General Hospital, University of Athens Medical School, 115 27 Athens, Greece
| | - Petros P. Sfikakis
- First Department of Propaedeutic and Internal Medicine, University of Athens Medical School, 115 27 Athens, Greece
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Moyssakis I, Gialafos E, Tentolouris N, Floudas CS, Papaioannou TG, Kostopoulos C, Latsi P, Vaiopoulos G, Votteas V, Rapti A. Impaired aortic elastic properties in patients with systemic sarcoidosis. Eur J Clin Invest 2008; 38:82-9. [PMID: 18226041 DOI: 10.1111/j.1365-2362.2007.01906.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Systemic sarcoidosis (Sar) is a granulomatous disorder involving multiple organs. Widespread vascular involvement and microangiopathy are common in patients with Sar. In addition, subclinical cardiac involvement is increasingly recognized in patients with Sar. However, data on the effect of Sar on the elastic properties of the arteries and myocardial performance are limited. In this study we looked for differences in aortic distensibility (AoD) which is an index of aortic elasticity, and myocardial performance of the ventricles, between patients with Sar and healthy subjects. In addition, we examined potential associations between AoD and clinical, respiratory and echocardiographic findings in patients with Sar. MATERIALS AND METHODS A total of 83 consecutive patients (26 male/57 female, mean age 51.1 +/- 13.3 years) with Sar, without cardiac symptoms, were included. All patients underwent echocardiographic and respiratory evaluation including lung function tests. Additionally, 83 age- and sex-matched healthy subjects served as controls. AoD was determined non-invasively by ultrasonography. RESULTS AoD was lower in the Sar compared to the control group (2.29 +/- 0.26 vs. 2.45 +/- 0.20 .10(-) (6) cm2 x dyn(-1), P < 0.01), while left ventricular mass (LVM) was higher in the Sar group (221.3 +/- 50.2 vs. 195.6 +/- 31.3 g, P = 0.007). Furthermore, myocardial performance of both ventricles was impaired in the Sar group. Multivariate linear regression analysis in the total sample population demonstrated a significant and independent inverse relationship between AoD and the presence of Sar (P < 0.001). The same analysis in the Sar patients showed that AoD was associated significantly and independently with the stage of Sar, age, systolic blood pressure, LVM and myocardial performance of both ventricles. No significant relationship was found between AoD and disease duration, pulmonary artery pressure or lung function tests. CONCLUSIONS Presence and severity of Sar are associated with reduced aortic distensibility, irrespective of the disease duration, pulmonary artery pressure and lung function. In addition, patients with Sar have increased LVM and impaired myocardial performance.
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Affiliation(s)
- I Moyssakis
- Department of Cardiology, Medical School, National University of Athens, Laiko Hospital, Athens, Greece.
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23
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Affiliation(s)
- Mary J Roman
- Division of Cardiology, Weill Medical College of Cornell University and the Hospital for Special Surgery, New York, NY 10021, USA.
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24
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Constans J, Germain C, Gosse P, Taillard J, Tiev K, Delevaux I, Mouthon L, Schmidt C, Granel F, Soria P, Lifermann F, Etienne G, Bonnet F, Zoulim K, Farge-Bancel D, Marie I, Allanore Y, Cabane J, Amonchot A, Macquin-Mavier I, Saves M, Zannad F, Conri C. Arterial stiffness predicts severe progression in systemic sclerosis: the ERAMS study. J Hypertens 2007; 25:1900-6. [PMID: 17762655 DOI: 10.1097/hjh.0b013e328244e1eb] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The ERAMS study addressed the value of arterial stiffness in predicting the severity of systemic sclerosis. METHODS ERAMS was a prospective multicentre cohort study including patients with definite systemic sclerosis. Arterial stiffness was measured by the standardized non-invasive QKd 100-60 method. Clinical evaluation, biological measurements, functional respiratory tests and cardiac Doppler echography were performed at inclusion then each year until 3 years' follow-up was completed. Progression was defined as mild (articulations, muscle, oesophagus or skin involvement) or severe (lung, heart or kidney involvement) by a critical event committee. The prediction of severe progression was studied for QKd 100-60 as well as clinical and biological data at baseline by univariate and multivariate analysis. RESULTS Ninety-nine patients were included (81 women, 18 men, mean age 57 years, standard deviation 12.5). Although their blood pressure profile was normal, half the patients had increased arterial stiffness (QKd 100-60<200 ms). There was a significant relationship between age-adjusted arterial stiffness and decrease in carbon dioxide diffusion (P<0.03) or haemoglobin rate (P<0.01). By univariate analysis, severe progression after 3 years was predicted by age (P=0.04), lung involvement (P=0.04), diffusion of lung carbon oxide (DLCO) (P<0.01), skin score (P=0.02), haemoglobin (P<0.01) and baseline Qkd 100-60 divided into two classes according to the median (P<0.01). By multivariate analysis, only haemoglobin rate [odds ratio (OR) 0.4, 95% confidence interval (CI) 0.2-0.9] and QKd 100-60 (OR 19.6, 95% CI 1.2-308.2) predicted severe progression of systemic sclerosis. CONCLUSION The measurement of arterial stiffness by the QKd method is a useful objective method for assessing the prognosis of systemic sclerosis independently from other data.
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Affiliation(s)
- Joël Constans
- Vascular and Internal Medicine Unit, CHU Bordeaux, Paris, France.
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25
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Sfikakis PP, Papamichael C, Stamatelopoulos KS, Tousoulis D, Fragiadaki KG, Katsichti P, Stefanadis C, Mavrikakis M. Improvement of vascular endothelial function using the oral endothelin receptor antagonist bosentan in patients with systemic sclerosis. ACTA ACUST UNITED AC 2007; 56:1985-93. [PMID: 17530638 DOI: 10.1002/art.22634] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Increased endothelin activity may play a role in the pathogenesis of vascular injury, a primary feature of systemic sclerosis (SSc; scleroderma). Our goal was to test the hypothesis that treatment with the oral endothelin receptor antagonist bosentan might improve vascular endothelial function in SSc patients. METHODS A 4-week, prospective, parallel-group study compared 12 SSc patients who did not receive bosentan treatment with 12 patients who did receive treatment (125 mg/day) for pulmonary hypertension and/or digital ulcers. There were no differences in demographic and clinical characteristics or medications between the 2 groups. Baseline endothelial dysfunction was documented by decreased brachial artery ultrasound-derived flow-mediated dilation (FMD%; <5.5). Pulse wave analysis, venous occlusion plethysmography, and measurement of serum vascular markers were performed in parallel. RESULTS FMD%, the main end point, increased significantly from a mean +/- SD of 3.1 +/- 1.3% to 8.4 +/- 2.6% after 4 weeks of bosentan treatment (P < 0.001, compared with a change from 2.4 +/- 1.6% to 2.4 +/- 2.2% in control patients). Arterial blood pressure, endothelium-independent vascular function, augmentation index, peripheral flow reserve, as well as circulating intercellular adhesion molecule 1, E-selectin, vascular endothelial growth factor, and endothelin 1 were not significantly affected by bosentan treatment. In patients continuously treated for 4 months, during which the dosage of bosentan remained at 125 mg/day (n = 5) or increased to 250 mg/day (n = 5), the 4-week results remained unchanged. CONCLUSION Small doses of bosentan improve endothelial function without affecting hemodynamic parameters or endothelial activation-related processes, thus supporting a direct, reversible effect of endothelin in SSc-associated vascular injury. A long-term, controlled trial to examine the potentially global clinical benefit of endothelin receptor blockade in patients with early SSc may be warranted.
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Affiliation(s)
- P P Sfikakis
- First Department of Propedeutic and Internal Medicine, Laikon Hospital, Athens University Medical School, Athens, Greece.
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Silveira-Torre LH. [Cardiac involvement in systemic sclerosis]. REUMATOLOGIA CLINICA 2006; 2 Suppl 3:S31-S36. [PMID: 21794385 DOI: 10.1016/s1699-258x(06)73105-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Systemic sclerosis (SS) can involve the pericardium, myocardium, conduction system, and cardiac valves. The presence of overt clinical signs of cardiac disease is a poor prognostic sign. Clinical manifestations include dyspnea, palpitations, chest pain, syncope, and symptoms of right heart failure. Prevalence of clinically symptomatic pericardial disease is 5-16%. However, ecocardiographic prevalence is 5.4- 41% and at autopsy is 33-77.5%. Patchy fibrosis is the characteristic myocardial finding in SS. Contraction band necrosis is the typical pathological finding. Important complications of fibrosis include left ventricular hypertrophy, as well as systolic and diastolic dysfunction of both ventricles. Early detection of these abnormalities is very important, mainly of the diastolic dysfunction, since it occurs before the systolic dysfunction and can predict important cardiac damage. Association of skeletal myositis with myocardial disease has been described. Patients with skeletal myositis are more likely to develop congestive heart failure, sustained symptomatic arrythmias, and cardiac sudden death. Coronary arteries are normal in systemic sclerosis, but there is no endomyocardial vessel involvement. There is an increased prevalence of arrhytmias, mainly premature atrial and ventricular contractions, as well as conduction system disease. Cardiac valvular involvement is minor in systemic sclerosis; mitral valve is the most frequently affected. Other abnormalities described in this disease include peripheral large vessels stiffness and secondary cardiac involvement due to pulmonary and systemic arterial hypertension. Cardiac involvement confers a high morbi-mortality risk in systemic sclerosis.
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Affiliation(s)
- Luis H Silveira-Torre
- Departamento de Bioquímica. Instituto Nacional de Cardiología Ignacio Chávez. México DF. México
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