Arterial stiffness predicts severe progression in systemic sclerosis: the ERAMS study.
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.


CONCLUSIONS
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.
Constans
Joël
J
Vascular and Internal Medicine Unit, CHU Bordeaux, Paris, France. joel.constans@chu-bordeaux.fr
Germain
Christine
C
Gosse
Philippe
P
Taillard
Jacques
J
Tiev
Kiet
K
Delevaux
Isabelle
I
Mouthon
Luc
L
Schmidt
Claude
C
Granel
Florence
F
Soria
Pascale
P
Lifermann
François
F
Etienne
Gabriel
G
Bonnet
Fabrice
F
Zoulim
Karim
K
Farge-Bancel
Dominique
D
Marie
Isabelle
I
Allanore
Yannick
Y
Cabane
Jean
J
Amonchot
Alain
A
Macquin-Mavier
Isabelle
I
Saves
Marianne
M
Zannad
Faiez
F
Conri
Claude
C
D000368:Aged; D001158:Arteries / Q000503:physiopathology*; D015331:Cohort Studies; D003187:Compliance; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012595:Scleroderma, Systemic / Q000503:physiopathology*