title: In systemic sclerosis macrovascular damage of hands digital arteries correlates with microvascular damage.
abstract: OBJECTIVE
  To assess morphology and blood flow of the proper palmar digital arteries (PPDA) by color Doppler ultrasonography (CDUS) and its relationship with nailfold videocapillaroscopy (NVC), skin blood perfusion and digital arteries pulsatility of hands in SSc patients and healthy controls.
  
  
  METHODS
  CDUS, NVC, laser Doppler perfusion imaging (LDPI) and photoplethysmography (PPG) were performed in 36 systemic sclerosis (SSc) patients and 20 healthy controls.
  
  
  RESULTS
  CDUS was pathologic in 69% of patients with SSc and in none of healthy controls (p<0.0001). SSc patients with low vascular damage (early capillaroscopic pattern) have a normal morphology of PPDA, but the blood flow, evaluated by peak systolic velocity (PSV) and end diastolic velocity (EDV), is reduced and vascular resistance, measured by resistive index (RI) and pulsatility index (PI), increased. At this stage the LDPI mean perfusion and digital artery pulsatility, evaluated by PPG, were reduced. The US changes appear with microvascular damage progression (active and late capillaroscopic patterns), while the PPDA blood flow progressively decreases (PSV and EDV decreased, RI and PI increased). The macrovascular damage correlates with disease duration. Anti-topoisomerase I represents an independent predictive factor for macrovascular damage. We not observed any association between digital ulcer history, pulmonary fibrosis and US findings.
  
  
  CONCLUSIONS
  PPDA blood flow dysfunction is already present in early disease. Structural macrovascular damage progresses with worsening of SSc microangiopathy.
authors.affiliation: Sapienza University of Rome, Department of Clinical Medicine, Clinical Immunology Unit-Scleroderma Center, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Rosato
authors.forename: Antonietta
authors.initials: A
authors.lastname: Gigante
authors.forename: Biagio
authors.initials: B
authors.lastname: Barbano
authors.forename: Rosario
authors.initials: R
authors.lastname: Cianci
authors.forename: Ilenia
authors.initials: I
authors.lastname: Molinaro
authors.forename: Simonetta
authors.initials: S
authors.lastname: Pisarri
authors.forename: Felice
authors.initials: F
authors.lastname: Salsano
mesh_terms: D000328:Adult; D001158:Arteries / Q000473:pathology; D001783:Blood Flow Velocity; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D005385:Fingers / Q000098:blood supply*; D006801:Humans; D007558:Italy; D017078:Laser-Doppler Flowmetry; D008297:Male; D008833:Microcirculation; D020678:Microscopic Angioscopy; D055806:Microvessels / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D017156:Photoplethysmography; D011237:Predictive Value of Tests; D011673:Pulsatile Flow; D012039:Regional Blood Flow; D012595:Scleroderma, Systemic / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D018615:Ultrasonography, Doppler, Color