Bartoloni Elena, Pucci Giacomo, Cannarile Francesca, Battista Francesca, Alunno Alessia, Giuliani Marco, Cafaro Giacomo, Gerli Roberto, Schillaci Giuseppe
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.).
Hypertension. 2016 Dec;68(6):1504-1511. doi: 10.1161/HYPERTENSIONAHA.116.08345. Epub 2016 Oct 17.
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.
尽管微血管疾病是系统性硬化症（SSc）的一个标志，但据报道，与普通人群相比，SSc患者中大血管疾病的患病率更高，且相关预后更差。目前尚未采用最先进的技术，对SSc患者较大和较小动脉的预后相关功能特性及其对中心血流动力学的影响进行同步评估。34名SSc女性患者（年龄61±15岁，病程17±12年，血压123/70±18/11 mmHg）和34名年龄及平均动脉压与之匹配的健康女性，接受了通过压平式眼压计（SphygmoCor）测定颈股（主动脉）和颈桡（上肢）脉搏波速度（动脉僵硬度的直接测量指标）、主动脉增强（反射波对中心脉压贡献的测量指标）以及主动脉肱动脉脉压放大率（肱动脉/主动脉脉压）。患者和对照组在颈股或颈桡脉搏波速度方面无差异。校正心率为75次/分钟后的主动脉增强指数（AIx@75）在SSc女性患者中更高（30.9±16% 对22.2±12%；P=0.012）。患者的主动脉肱动脉脉压放大率也更低（1.22±0.18对1.33±0.25；P=0.041）。SSc是AIx@75（直接相关）和脉压放大率（负相关）的独立预测因素。在患者中，年龄、平均动脉压和C反应蛋白独立预测颈股脉搏波速度。年龄和平均动脉压是AIx@75的唯一预测因素。SSc女性患者的主动脉增强增加，脉压放大率降低（两者均为反射波对中心波形贡献的测量指标），但主动脉或上肢动脉僵硬度无变化。在SSc中，微血管受累早于大动脉僵硬化。
