Discrepancy between simultaneous digital skin microvascular and brachial artery macrovascular post-occlusive hyperemia in systemic sclerosis.
OBJECTIVE
Vascular impairment, a main feature of the pathogenesis of systemic sclerosis (SSc), involves both the macro- and the microvasculature. We compared and correlated simultaneously measured skin microvascular and brachial artery macrovascular post-occlusive hyperemia in 3 groups: patients with SSc, patients with primary Raynaud's phenomenon (RP), and healthy volunteers.


METHODS
Thirty-three healthy volunteers, 36 patients with primary RP, and 42 patients with SSc were enrolled. For each subject, brachial artery flow-mediated dilation (FMD) and cutaneous post-occlusive reactive hyperemia (PORH) were simultaneously recorded after 5-minute occlusion of the brachial artery. Local thermal hyperemia, nitroglycerin-mediated dilation (NMD), intima-media thickness (IMT), and pulse wave velocity (PWV) were also assessed.


RESULTS
Digital cutaneous peak PORH was altered in patients with primary RP and SSc compared to healthy controls, whereas FMD was not significantly different among all groups. We observed a correlation between digital peak cutaneous vascular conductance and brachial FMD in healthy controls (r = 0.49; p = 0.004), but not in patients with primary RP or SSc. Thermal hyperemia was altered only in patients with SSc. Brachial NMD, IMT, and PWV were not different among all groups.


CONCLUSIONS
We observed a loss of the correlation between brachial FMD and digital cutaneous PORH in patients with SSc and primary RP. Microvascular function is impaired in SSc, whereas brachial artery endothelial function is normal.
Roustit
Matthieu
M
Clinical Research Center, INSERM CIC03, Grenoble University Hospital, Grenoble, France.
Simmons
Grant H
GH
Baguet
Jean-Philippe
JP
Carpentier
Patrick
P
Cracowski
Jean-Luc
JL
D000328:Adult; D000368:Aged; D001916:Brachial Artery / Q000502:physiology*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D008297:Male; D055806:Microvessels / Q000503:physiopathology*; D008875:Middle Aged; D011928:Raynaud Disease / Q000150:complications / Q000503:physiopathology; D012039:Regional Blood Flow / Q000502:physiology; D012595:Scleroderma, Systemic / Q000150:complications / Q000503:physiopathology*; D012867:Skin / Q000098:blood supply*