title: Central Hemodynamics and Arterial Stiffness in Systemic Sclerosis.
abstract: Although microvascular disease is a hallmark of systemic sclerosis (SSc), a higher prevalence of macrovascular disease and a poorer related prognosis have been reported in SSc than in the general population. The simultaneous assessment of prognostically relevant functional properties of larger and smaller arteries, and their effects on central hemodynamics, has never been performed in SSc using the state-of-the-art techniques. Thirty-four women with SSc (aged 61±15 years, disease duration 17±12 years, and blood pressure 123/70±18/11 mm Hg) and 34 healthy women individually matched by age and mean arterial pressure underwent the determination of carotid-femoral (aortic) and carotid-radial (upper limb) pulse wave velocity (a direct measure of arterial stiffness), aortic augmentation (a measure of the contribution of reflected wave to central pulse pressure), and aortobrachial pulse pressure amplification (brachial/aortic pulse pressure) through applanation tonometry (SphygmoCor). Patients and controls did not differ by carotid-femoral or carotid-radial pulse wave velocity. Aortic augmentation index corrected for a heart rate of 75 bpm (AIx@75) was higher in women with SSc (30.9±16% versus 22.2±12%; P=0.012). Patients also had a lower aortobrachial amplification of pulse pressure (1.22±0.18 versus 1.33±0.25; P=0.041). SSc was an independent predictor of AIx@75 (direct) and pulse pressure amplification (inverse). Among patients, age, mean arterial pressure, and C-reactive protein independently predicted carotid-femoral pulse wave velocity. Age and mean arterial pressure were the only predictors of AIx@75. Women with SSc have increased aortic augmentation and decreased pulse pressure amplification (both measures of the contribution of reflected wave to central waveform) but no changes in aortic or upper limb arterial stiffness. Microvascular involvement occurs earlier than large artery stiffening in SSc.
authors.affiliation: From the Rheumatology Unit, Department of Medicine, University of Perugia, Italy (E.B., G.P., F.C., F.B., A.A., M.G., G.C., R.G., G.S.); and Unit of Internal Medicine, Department of Medicine, Terni University Hospital, Italy (G.P., F.B., M.G., G.S.).
authors.forename: Elena
authors.initials: E
authors.lastname: Bartoloni
authors.affiliation: From the Rheumatology Unit, Department of Medicine, University of Perugia, Italy (E.B., G.P., F.C., F.B., A.A., M.G., G.C., R.G., G.S.); and Unit of Internal Medicine, Department of Medicine, Terni University Hospital, Italy (G.P., F.B., M.G., G.S.).
authors.forename: Giacomo
authors.initials: G
authors.lastname: Pucci
authors.affiliation: From the Rheumatology Unit, Department of Medicine, University of Perugia, Italy (E.B., G.P., F.C., F.B., A.A., M.G., G.C., R.G., G.S.); and Unit of Internal Medicine, Department of Medicine, Terni University Hospital, Italy (G.P., F.B., M.G., G.S.).
authors.forename: Francesca
authors.initials: F
authors.lastname: Cannarile
authors.affiliation: From the Rheumatology Unit, Department of Medicine, University of Perugia, Italy (E.B., G.P., F.C., F.B., A.A., M.G., G.C., R.G., G.S.); and Unit of Internal Medicine, Department of Medicine, Terni University Hospital, Italy (G.P., F.B., M.G., G.S.).
authors.forename: Francesca
authors.initials: F
authors.lastname: Battista
authors.affiliation: From the Rheumatology Unit, Department of Medicine, University of Perugia, Italy (E.B., G.P., F.C., F.B., A.A., M.G., G.C., R.G., G.S.); and Unit of Internal Medicine, Department of Medicine, Terni University Hospital, Italy (G.P., F.B., M.G., G.S.).
authors.forename: Alessia
authors.initials: A
authors.lastname: Alunno
authors.affiliation: From the Rheumatology Unit, Department of Medicine, University of Perugia, Italy (E.B., G.P., F.C., F.B., A.A., M.G., G.C., R.G., G.S.); and Unit of Internal Medicine, Department of Medicine, Terni University Hospital, Italy (G.P., F.B., M.G., G.S.).
authors.forename: Marco
authors.initials: M
authors.lastname: Giuliani
authors.affiliation: From the Rheumatology Unit, Department of Medicine, University of Perugia, Italy (E.B., G.P., F.C., F.B., A.A., M.G., G.C., R.G., G.S.); and Unit of Internal Medicine, Department of Medicine, Terni University Hospital, Italy (G.P., F.B., M.G., G.S.).
authors.forename: Giacomo
authors.initials: G
authors.lastname: Cafaro
authors.affiliation: From the Rheumatology Unit, Department of Medicine, University of Perugia, Italy (E.B., G.P., F.C., F.B., A.A., M.G., G.C., R.G., G.S.); and Unit of Internal Medicine, Department of Medicine, Terni University Hospital, Italy (G.P., F.B., M.G., G.S.). roberto.gerli@unipg.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gerli
authors.affiliation: From the Rheumatology Unit, Department of Medicine, University of Perugia, Italy (E.B., G.P., F.C., F.B., A.A., M.G., G.C., R.G., G.S.); and Unit of Internal Medicine, Department of Medicine, Terni University Hospital, Italy (G.P., F.B., M.G., G.S.).
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Schillaci
mesh_terms: D000367:Age Factors; D000368:Aged; D062186:Arterial Pressure / Q000502:physiology; D001783:Blood Flow Velocity / Q000502:physiology; D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D016014:Linear Models; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D018570:Risk Assessment; D012595:Scleroderma, Systemic / Q000503:physiopathology*; D012720:Severity of Illness Index; D059289:Vascular Stiffness / Q000502:physiology*
keywords: C-reactive protein; atherosclerosis; blood pressure; cardiovascular disease; prognosis