title: Brachial artery endothelial-dependent flow-mediated dilation identifies early-stage endothelial dysfunction in systemic sclerosis and correlates with nailfold microvascular impairment.
abstract: OBJECTIVE
  To assess possible correlations between endothelial-dependent flow-mediated dilation (FMD) of the brachial artery and nailfold videocapillaroscopy (NVC) in patients with systemic sclerosis (SSc). Evidence has shown that vascular impairment in SSc may be a sign of endothelial dysfunction involving both microvascular and macrovascular systems, although the pathological mechanisms of the dysfunction are poorly understood.
  
  
  METHODS
  Forty-three consecutive patients (mean age 51 +/- 11 yrs) with SSc were studied. Thirty patients had limited cutaneous SSc, 13 had diffuse cutaneous SSc. Twenty-seven healthy subjects (mean age 48 +/- 8 yrs) were recruited as controls. Ultrasound assessment of FMD was performed on all subjects in order to evaluate macrovascular function. Patients were divided into 3 patterns of microvascular damage on the basis of NVC (early, active, and late), and the microangiopathy evolution score was calculated, as reported elsewhere.
  
  
  RESULTS
  FMD was significantly reduced in patients with SSc compared to healthy subjects [median 8.0% (3.0%-9.0%) vs 15.0% (12.0%-16.0%), respectively; p < 0.0001]. Patients with an early pattern of microangiopathy showed reduced FMD values compared to controls (p = 0.0001). FMD was significantly reduced in patients with SSc who had the late NVC pattern of microangiopathy compared to active and early patterns (p = 0.003 and p = 0.001, respectively). FMD was inversely correlated with the microvascular damage rate in patients with SSc (p < 0.0001).
  
  
  CONCLUSIONS
  We demonstrated the simultaneous presence of macrovascular and microvascular impairment in patients with SSc, which was already present in the early phase of the vascular disease.
authors.affiliation: Academic Unit of Cardiovascular Diseases, Department of Internal Medicine, University of Genoa, Genoa, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Rollando
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Bezante
authors.forename: Alberto
authors.initials: A
authors.lastname: Sulli
authors.forename: Manrico
authors.initials: M
authors.lastname: Balbi
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Panico
authors.forename: Carmen
authors.initials: C
authors.lastname: Pizzorni
authors.forename: Simone
authors.initials: S
authors.lastname: Negrini
authors.forename: Claudio
authors.initials: C
authors.lastname: Brunelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Barsotti
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cutolo
authors.forename: Francesco
authors.initials: F
authors.lastname: Indiveri
authors.forename: Massimo
authors.initials: M
authors.lastname: Ghio
mesh_terms: D001783:Blood Flow Velocity; D001916:Brachial Artery / Q000473:pathology* / Q000503:physiopathology; D002196:Capillaries / Q000473:pathology; D004730:Endothelium, Vascular / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D020678:Microscopic Angioscopy / Q000379:methods; D008875:Middle Aged; D009262:Nails / Q000098:blood supply*; D011928:Raynaud Disease / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D045743:Scleroderma, Diffuse / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D045745:Scleroderma, Limited / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology