[OP.3B.03] INFLUENCE OF SUBCLINICAL RENAL DAMAGE ON EARLY VASCULAR AGING IN PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Objective: It is well known that kidney is frequently involved in patients with Systemic Lupus Erythematosus (SLE) However, conflicting data exist about the impact of renal involvement on vascular damage in this group of patients. The aim of this study was to evaluate the influence of renal damage on assessed by aortic pulse wave velocity (aPWV), evaluated a by intima-media thickness (IMT) measurement and assessed by renal resistive index (RRI) measurement, in patients with SLE. Design and method: We enrolled 52 SLE subjects (mean age 39 +/- 12 years), divided in two subgroups according to ACR/SLICC classification: patients with lupus nephritis, (LNG), and individuals presenting other features of SLE (Non Lupus Nephritis group, NLNG), compared to 20 age and sex matched healthy subjects. Each patient performed routine blood chemistry, ultrasonographic renal RI, ambulatory blood pressure measurement (ABPM), aPWV through an oscillometric device and ultrasound evaluation of carotid IMT. Results: These groups did not differ regarding clinical and demographic characteristics and 24-hour blood pressures Despite this, lupus patients showed higher values of IMT (ANOVA p = 0.0001), of aPWV (p < 0.01) and of RRI (p = 0.02) when compared to those of CG. NLNG showed similar values of IMT, aPWV, RRI and a lower percentage of patient treated with immunosuppressive drugs when compared to LNG (p = 0.0001). When the SLE patients were re-classified according to KDIGO classification, in 1) patients without Cronich Kidney Disease: NCKD), 2) patients with preclinical renal damage (PCKD) and 3) patients with clinical renal damage we observed that PCKD group showed higher values of IMT and aPWV in comparison to those of CCKD (both p = 0.001) and of NCKD groups (both p = 0.001), but similar RRI (p = ns). The percentage of patients treated with immunosopressive drugs was similar in PCKD group when compared to that of NCKD group, but lower than CCKD group (p = 0.05). Conclusions: Our results suggest that a good treatment in lupus nephritis leads to a reduced vascular involvement, and overall, being subclinical renal damage a powerful predictor of cardiovascular events, SLICC criteria should be reconsidered in order to avoid an under diagnosis and treatment of renal involvement in SLE patients

Early Vascular Aging in Normotensive Patients With Systemic Lupus Erythematosus: Comparison With Young Patients Having Hypertension.

Connective tissue diseases, like systemic lupus erythematosus (SLE), are associated with early and accelerated atherosclerosis. Recently, the concept of "early vascular aging" (EVA) has been more widely accepted. Aortic stiffness is one of the important markers of EVA. We evaluated EVA and subclinical atherosclerosis, by measuring aortic pulse wave velocity (aPWV) and carotid intima-media thickness (cIMT), in 50 normotensive patients with SLE (mean age: 39 ± 12 years). We compared these participants with 50 age- and sex-matched patients with essential hypertension (EH) and 20 healthy controls. Each participant underwent 24-hour ambulatory blood pressure monitoring (ABPM), aPWV, and cIMT measurements. Clinic and 24-hour ABPM values were significantly lower in patients with SLE and controls when compared with the participants having EH (all P < .0001), but aPWV and cIMT were significantly lower in the control group when compared with patients having SLE and EH (all P < .001). Overall, patients with SLE and EH had similar cIMT and aPWV values (P = .31 and P = .47, respectively). Our results suggest that SLE has a similar deleterious impact on EVA as EH

EARLY VASCULAR AGING IN NORMOTENSIVE SUBJECTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS. COMPARISON WITH YOUNG HYPERTENSIVE PATIENTS

Introduction: It is well known that connective tissue diseases, like Systemic Lupus Erythematosus, are associated with early and accelerated atherosclerosis. During the last year, it has well established the concept of ‘‘Early vascular aging’’ (EVA), whose the aortic stiffness represents one of the most important markers. Aim: To evaluate early vascular aging, assessed by measuring Aortic pulse wave velocity (aPWV), as an arterial stiffness index, in a group of normotensive patients with SLE and to compare these subjects with a group of young essential hypertensive (EH) individuals.Methods: In this cross-sectional study we have enrolled 50 normotensive SLE subjects (45 women and 5 men) with mean age of 39 ± 11.6 years matched for age and sex with a group of essential hypertensive patients (mean age 39 ± 10.8 years, 45 women and 5 men) and with a control group of health volunteers. Each patient has been underwent to 24-h ambulatory blood pressure measurement (ABPM) and to aPWV measurement through an oscillometric device (Arteriograph). Results: Clinic and 24-h systolic and diastolic blood pressure values were significantly lower in the SLE patients and in control group patients when compared to those of the hypertensive subjects (all p&lt; 0.005). Despite this difference regarding BP, aPWV and IMT were not different between the two studied groups, being respectively PWV: 8.8 ± 2 m/s; IMT: 0.81 ± 0.2 I n SLE subjects and PWV: 9.5 ± 2 m/s IMT 0.77 ± 0.2 in the group of young essential hypertensive patients; p[0.05. In both groups aPWV was greater than that of the normal population in the same age category (7.1 m/s). In addition to this, the number of patients with higher value of aPWV than 10 m/s (cut off that identifies who has more cardiovascular risk) it hasn’t been significant different between SLE patients (26 %) and hypertensive ones (38 %) Conclusions: Our results seem to suggest that SLE has the same deleterious impact on vascular aging as well as high blood pressure. It is very likely that this unfavourable effect of SLE is mediated by chronic inflammation

CORRELATIONS BETWEEN NON INVASIVE RENAL INDEX AND MARKERS OF ATHEROSCLEROSIS IN LUPUS PATIENTS.

Objective: Recent data suggest that renal haemodynamic parameters obtained by duplex Doppler sonography, especially the intrarenal resistive index (RI), may be associated with systemic vascular changes in some groups of patients. However, conflicting data exist about the relationship between aortic stiffness and RI in autoimmune disease, like systemic lupus The aim of this study was to evaluate the relationship between RI and arterial stiffness, assessed by aortic pulse wave velocity (aPWV), and carotid atherosclerosis, evaluated by intimal medial thickness measurement(IMT) in patients with SLE. Design and method: Cross-sectional study. We enrolled 39 SLE subjects (mean age 39 years). Each patient underwent assessment of ultrasonographic renal RI, IP, measurement of aPWV through oscillometric device, and ultrasound evaluation of carotid IMT. Results: IR correlated significantly with aortic PWV(r: 0,44; p = 0.006), and with carotid IMT (r: 0,46; p = 0.003) in the study population. Conclusions: Our results seems to suggest that, as previously demonstrated in other populations, the RI may be considered as a marker of systemic vascular changes and probably a predictor of cardiovascular risk also in SLE patients

Association of renal resistive index with aortic pulse wave velocity in hypertensive patients

Background: Recent data suggest that renal haemodynamic parameters obtained by duplex Doppler sonography, especially the intrarenal resistive index (RI), may be associated with systemic vascular changes. However, conflicting data exist about the independent relationship between aortic stiffness and RI. The aim of this study was to evaluate the relationship between RI and arterial stiffness, assessed by aortic pulse wave velocity (aPWV), in hypertensive patients. Design: Cross-sectional study. Methods: We enrolled 264 hypertensive subjects aged between 30 and 70 years. They were divided into two groups, either with normal renal function (n=140) or with chronic kidney disease (CKD) (n=124). Each patient underwent assessment of ultrasonographic renal RI and measurement of aPWV through oscillometric device. Results: Patients with renal RI&gt;0.7 showed higher values of aPWV, both in the overall population (p&lt;0.001) and in the subgroups with (p&lt;0.01) and without CKD (p&lt;0.01). Moreover, statistically significant correlations were observed between aPWV and RI in the whole population (r=0.38, p&lt;0.001) and in the subgroups with (r=0.35, p&lt;0.001) and without CKD (r=0.31, p&lt;0.001). These correlations held even after adjustment for several confounding factors in multivariate analyses. Conclusions: Our results seem to corroborate the concept that the RI may be considered as a marker of systemic vascular changes and therefore a predictor of cardiovascular risk

ASSOCIATION OF RENAL RESISTIVE INDEX WITH MARKERS OF EXTRARENAL VASCULAR CHANGES IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Introduction: Recent data suggest that renal hemodynamic parameters obtained by duplex Doppler sonography, especially the intrarenal resistive index (RRI), may be associated with systemic vascular changes. However, limited and conflicting data exist about the relationship between aortic stiffness and RI in autoimmune diseases, like systemic lupus erythematosus (SLE). Aim: To evaluate the relationship between RRI and arterial stiffness, assessed by aortic pulse wave velocity (aPWV), and between RRI and carotid atherosclerosis, evaluated by intima-media thickness (IMT) measurement in patients with SLE. Methods: In this cross-sectional study, we enrolled 39 SLE subjects (mean age 39 years) that were compared with a control group of healthy individuals, matched for age and sex. In all subjects routine blood chemistry and standard urinalysis were obtained. Each patient performed ultrasonographic renal RI, 24-h ambulatory blood pressure measurement (ABPM), aPWV through an oscillometric device and ultrasound evaluation of carotid IMTResults: RI correlated significantly with aortic PWV (r: 0.44; p = 0.006), and with carotid IMT (r: 0.46; p = 0.003) in the study population (Figure). Both correlations held (p = 0.01) even after correction for age, mean arterial pressure, and glomerular filtration rate. Conclusions: Our results seems to suggest that, as previously demonstrated in other clinical settings, the RRI may be considered a marker of systemic vascular changes and probably a predictor of cardiovascular risk also in SLE patients

PREVALENZA DI IPERTROFIA VENTRICOLARE SINISTRA NELL’IPERTENSIONE ARTERIOSA: RIVALUTAZIONE CON I NUOVI CUT-OFF

Nelle linee guida 2013 ESH/ESC per il trattamento dell’ipertensione arteriosa si consiglia di utilizzare come cut-off per l’ipertrofia ventricolare sinistra (LVH) valutata con ecocardiografia, 95 g/m2 per il sesso femminile e 110 g/m2 per il sesso maschile e spessore parietale relativo (RWT) 0,42 per differenziare la forma concentrica dalla forma eccentrica. Tali cut-off sono diversi da quelli suggeriti nella versione precedente delle linee guida (110 g/m2 per il sesso femminile, 125 g/m2 per il sesso maschile e 0.45 per RWT). Scopo del presente studio è di valutare se tale variazione abbia determinato variazioni di rilievo nella valutazione della prevalenza di LVH nei pazienti ipertesi. A tal fine abbiamo valutato la prevalenza di LVH in una popolazione di 480 pazienti con ipertensione arteriosa essenziale (M/F 258/232) con un’età media di 56±10 anni. Utilizzando i cut-off delle linee guida 2013 la prevalenza di LVH era pari al 40.6% rispetto al 26.2% ottenuto con i cut-off precedenti; nel sesso femminile era pari al 40.1% (vs 22%) e nel sesso maschile era pari al 39.5% (vs 29.1%). La forma concentrica era presente nel 64% dei pazienti con LVH (vs 66%). I dati ottenuti evidenziano un notevole incremento della prevalenza di LVH in pazienti con ipertensione arteriosa essenziale utilizzando i cut-off suggeriti nelle ultime linee guida, senza sostanziali variazioni tra le forme concentriche ed eccentriche. Queste variazioni hanno una ricaduta importante nella stratificazione del rischio cardiovascolare del paziente iperteso