title: A comparative study of arterial stiffness, flow-mediated vasodilation of the brachial artery, and the thickness of the carotid artery intima-media in patients with systemic autoimmune diseases.
abstract: Patients with autoimmune diseases may have increased vascular risk leading to higher mortality rates. Novel imaging techniques are necessary for the early assessment and management of these patients. In this study, we compared augmentation index (AIx) and pulse wave velocity (PWV), indicators of arterial stiffness, to brachial arterial flow-mediated vasodilation (FMD) and common carotid artery intima-media thickness (ccIMT), standard indicators of endothelial dysfunction and atherosclerosis, respectively. We wished to assess the vascular status of autoimmune patients by using a novel, cheap, and reproducible technique, the arteriograph. Altogether, 101 patients with systemic autoimmune diseases including primary antiphospholipid syndrome, systemic sclerosis, rheumatoid arthritis, and polymyositis, all having various types of vasculopathies, as well as 36 healthy individuals were investigated. Arterial stiffness was assessed by a TensioClinic arteriograph, a recently validated technique. Brachial arterial FMD and ccIMT were determined using high-resolution ultrasonography. Autoimmune patients exerted impaired FMD (3.7 +/- 3.8%), increased ccIMT (0.7 +/- 0.2 mm), AIx (1.2 +/- 32.2%), and PWV (9.7 +/- 2.4 m/s) in comparison to control subjects (FMD = 8.4 +/- 4.0%; ccIMT = 0.6 +/- 0.1 mm; Aix = -41.1 +/- 22.5%; PWV = 8.0 +/- 1.5 m/s; p < 0.05). We found a significant negative correlation of FMD with AIx (R = -0.64; p < 0.0001) and PWV (R = -0.37; p = 0.00014). There were significant positive correlations between ccIMT and AIx (R = 0.34; p = 0.0009), ccIMT and PWV (R = 0.44; p < 0.0001), as well as AIx and PWV (R = 0.47; p < 0.0001). AIx, PWV, and ccIMT positively correlated and FMD negatively correlated with the age of the autoimmune patients. Arterial stiffness indicated by increased AIx and PWV may be strongly associated with endothelial dysfunction and overt atherosclerosis in patients with autoimmune diseases. Assessment of arterial stiffness, FMD, and ccIMT are reproducible and reliable noninvasive techniques for the complex assessment of vascular abnormalities in patients at high risk.
authors.affiliation: Cardiovascular Unit, Institute of Medicine, Third Department of Medicine, University of Debrecen Medical and Health Science Center, Debrecen, 4032, Hungary.
authors.forename: Pál
authors.initials: P
authors.lastname: Soltész
authors.forename: Henriett
authors.initials: H
authors.lastname: Dér
authors.forename: György
authors.initials: G
authors.lastname: Kerekes
authors.forename: Péter
authors.initials: P
authors.lastname: Szodoray
authors.forename: Gabriella
authors.initials: G
authors.lastname: Szücs
authors.forename: Katalin
authors.initials: K
authors.lastname: Dankó
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Shoenfeld
authors.forename: Gyula
authors.initials: G
authors.lastname: Szegedi
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Szekanecz
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D016736:Antiphospholipid Syndrome / Q000503:physiopathology; D001172:Arthritis, Rheumatoid / Q000503:physiopathology; D050197:Atherosclerosis / Q000503:physiopathology; D001327:Autoimmune Diseases / Q000503:physiopathology*; D001783:Blood Flow Velocity / Q000502:physiology; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D016022:Case-Control Studies; D004548:Elasticity / Q000502:physiology*; D004730:Endothelium, Vascular / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017285:Polymyositis / Q000503:physiopathology; D012595:Scleroderma, Systemic / Q000503:physiopathology; D017539:Tunica Intima / Q000000981:diagnostic imaging*; D017540:Tunica Media / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D014664:Vasodilation / Q000502:physiology*