Assessment of systemic and pulmonary arterial remodelling in women with systemic sclerosis.
OBJECTIVE
Systemic sclerosis (SSc) leads to pulmonary circulation dysfunctionand there are some indications of systemic circulation impairment. We evaluated the influence of SSc on the elastic properties of large systemic arterial walls and potential correlations between systemic and pulmonary circulation involvement.


METHODS
We examined 75 consecutive women (mean age 53.13±10.1 years) with confirmed SSc [mean disease duration (DD) 7.1±9.1 years] and 21 age-matched female volunteers (mean age 52.6±8.3 years, ns). Pulse wave velocity (PWV) and transthoracic echocardiography were performed. SSc patients were divided into two groups according to the median of DD: ≤3 years (39 patients) and >3 years (36 patients).


RESULTS
Patients with DD>3 years had higher PWV than those with DD≤3 years and controls (log PWV: 2.23±0.23 vs. 2.13±0.16 and vs. 2.11±0.16 m/s; p=0.028 and 0.029, respectively). In addition, echocardiographic indices showed impaired right ventricular (RV) function in the patients with DD>3 years. Also in these SSc patients, PWV correlated with clinical and echocardiographic parameters of pulmonary circulation: age (r=0.64, p<0.0001), acceleration time of pulmonary ejection (AcT; r=-0.38, p=0.021), and tricuspid regurgitation peak gradient (TRPG; r=0.34, p=0.04). Multiple linear regression analysis showed that PWV was independently associated with DD (β=0.22, p==0.02), AcT (β=-0.215, p=0.03), and age (β=0.44, p<0.001).


CONCLUSIONS
In patients with SSc lasting more than 3 years, the disease is characterized by increased stiffness of the large systemic arteries. Longer duration of SSc leads simultaneously to the increased stiffness of the large systemic arteries and to the progressive impairment of RV function and its coupling to the pulmonary arterial bed.
a Department of Internal Medicine and Cardiology with the Centre for Diagnosis and Treatment of Venous Thromboembolism , Medical University of Warsaw , Warsaw , Poland.
K
K
Irzyk
a Department of Internal Medicine and Cardiology with the Centre for Diagnosis and Treatment of Venous Thromboembolism , Medical University of Warsaw , Warsaw , Poland.
P
P
Bienias
a Department of Internal Medicine and Cardiology with the Centre for Diagnosis and Treatment of Venous Thromboembolism , Medical University of Warsaw , Warsaw , Poland.
Z
Z
Rymarczyk
b Department of Internal Medicine and Endocrinology , Medical University of Warsaw , Warsaw , Poland.|c Department of Endocrinology , Warsaw Medical Research Centre of the Polish Academy of Science , Warsaw , Poland.
Z
Z
Bartoszewicz
d Department of Dermatology , Medical University of Warsaw , Warsaw , Poland.
M
M
Siwicka
e Department of Psychology , University of Social Sciences and Humanities , Warsaw , Poland.
M
M
Bielecki
a Department of Internal Medicine and Cardiology with the Centre for Diagnosis and Treatment of Venous Thromboembolism , Medical University of Warsaw , Warsaw , Poland.
A
A
Karpińska
a Department of Internal Medicine and Cardiology with the Centre for Diagnosis and Treatment of Venous Thromboembolism , Medical University of Warsaw , Warsaw , Poland.
I
I
Dudzik-Niewiadomska
a Department of Internal Medicine and Cardiology with the Centre for Diagnosis and Treatment of Venous Thromboembolism , Medical University of Warsaw , Warsaw , Poland.
P
P
Pruszczyk
a Department of Internal Medicine and Cardiology with the Centre for Diagnosis and Treatment of Venous Thromboembolism , Medical University of Warsaw , Warsaw , Poland.
M
M
Ciurzyński
D000328:Adult; D001158:Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016022:Case-Control Studies; D004452:Echocardiography; D004548:Elasticity / Q000502:physiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012595:Scleroderma, Systemic / Q000000981:diagnostic imaging / Q000503:physiopathology*; D066253:Vascular Remodeling / Q000502:physiology*; D018497:Ventricular Dysfunction, Right / Q000453:epidemiology