9 research outputs found
Non-Invasive Assessment of Micro- and Macrovascular Function after Initiation of JAK Inhibitors in Patients with Rheumatoid Arthritis
Background: Janus kinase (JAK) inhibitors constitute a novel class of oral biologic disease-modifying antirheumatic drugs for patients with rheumatoid arthritis (RA). However, their use has been associated with increased risk of major cardiovascular events. We investigated whether treatment with JAK inhibitors exerts significant alterations in the micro- and microvasculature in RA patients. Methods: Thirteen patients with RA initiating treatment with JAK inhibitors were prospectively studied. Eventually, data from 11 patients who completed the study were analyzed. Procedures were performed at baseline and 3 months after treatment. Nailfold videocapillaroscopy was applied to detect alterations of the dermal capillary network. Participants underwent 24 h ambulatory blood pressure monitoring (Mobil-O-Graph device) for the assessment of blood pressure (both brachial and aortic) and markers of large artery stiffening [pulse wave velocity (PWV), augmentation index] throughout the whole 24 h and the respective day- and nighttime periods. Carotid intima–media thickness was assessed with ultrasound. Results: Three-month treatment with JAK inhibitors was not associated with any differences in brachial and aortic blood pressure, arterial stiffness, and carotid atherosclerosis, with the only exception of nighttime PWV, which was significantly elevated at follow-up. However, three-month treatment with JAK inhibitors induced significant microvascular alterations and increased the total number of capillaroscopic abnormalities. Conclusions: Three-month treatment with JAK inhibitors may exert significant effects on microcirculation as assessed with nailfold videocapillaroscopy, whereas macrovascular structure and function appears largely unaffected. Further research toward this direction may add substantial information to the available literature regarding cardiovascular aspects of JAK inhibitors in RA
Right Ventricular Morphology and Function after Exercise Training in People with Systemic Sclerosis: A Randomized Controlled Pilot Study.
Background: Vascular dysfunction and its concomitant multi-organ involvement, including cardiac involvement, affects prognosis in systemic sclerosis (SSc) patients. Regular exercise has demonstrated to be able to improve vascular function in SSc. However, the effects of an exercise program on the heart and specifically in right ventricular (RV) morphology and function in SSc have yet to be explored. The study aimed to examine whether a 3-month combined exercise program can affect RV morphology and function in SSc patients. Methods: Twenty-eight SSc patients were randomly allocated to either the exercise training (ET) or the control (CON) group. Baseline and follow-up assessments consisted of a cardiopulmonary exercise test along with both a conventional and a two-dimensional speckle tracking echocardiography (2DSTE) focused on RV morphology and function. Following the baseline assessments, Group ET participated in a supervised combined exercise program for 12 weeks, while group CON received their usual care. Results: The ET group demonstrated increases in peak oxygen consumption by 25.1% (p < 0.001), global RV free wall longitudinal systolic strain by 6.69% (p < 0.03), RV free wall longitudinal systolic strain of the basal segment by 13.5% (p < 0.001), and global RV four-chamber longitudinal systolic strain by 6.76% (p < 0.03) following the exercise program. No differences were observed in group CON. Conclusions: Combined exercise improved cardiorespiratory efficiency and indices of RV systolic function, as assessed by the 2DSTE, in SSc patients
Cardiovascular risk in systemic sclerosis: Micro- and Macro-vascular involvement
Systemic sclerosis (SSc) is an autoimmune disease characterized by fibrosis of multiple organs (kidney, heart, lung, gastrointestinal tract, and skin), endothelial damage leading to vascular disease, and autoantibody production. Although the microvascular disease is well-understood, mechanistic insights explaining the presence and extent of macrovascular disease in SSc patients has been a matter of intense debate, especially in the past few years. Patients with systemic sclerosis have an increased risk for atherosclerotic cardiovascular disease (CVD), possibly mediated by inflammatory and fibrotic mechanisms. The excess cardiovascular risk in SSc is suggested by increased arterial stiffness, carotid intima thickening, and reduced flow-mediated dilatation. Given the involvement of the microvasculature, the differentiation between primary and ischemic heart disease is difficult. There is a relative paucity of data regarding clinical and preclinical CVD in SSc. Therefore, large cohort studies are required to clarify whether CVD is predominantly associated with atherosclerosis or microvascular involvement. The aim of this review is to discuss primary and ischemic heart disease and their contribution to CVD in SSc
Cardiovascular Risk in Systemic Sclerosis
Purpose of reviewSystemic sclerosis (SSc) is a systemic inflammatory,
autoimmune disorder characterized by diffuse fibrosis of the skin and
visceral organ involvement. Endothelial dysfunction and microvascular
injury dominate the pathophysiology and clinical manifestations of the
disease, while the impact of macrovascular atherosclerotic disease on
cardiovascular (CVD) morbidity and mortality is yet to be established.
In this article, we aim to review current knowledge about CVD as well as
cardiac complications in SSc and discuss the potentially implicated
pathogenetic mechanisms.Recent findingsSystemic inflammation has been
identified as an important trigger and contributor for the development
and progression of atherosclerosis, closely associated with high
cardiovascular mortality in patients with autoimmune disorders, such as
rheumatoid arthritis. A close interplay between traditional risk factors
and factors related to the disease, including inflammation, endothelial
injury, and immune-mediated cytotoxicity, sharing common pathogenetic
features with microvasculopathy, may be responsible for large-vessel
involvement and promotion of atherosclerosis in SSc. Cardiac
complications, including heart failure due to impairment of coronary
microcirculation and myocardial fibrosis, are listed among the primary
cause of death in SSc. Evaluation of indirect surrogate markers of CVD,
namely, arterial stiffness, carotid media thickness, and flow-mediated
dilation, in small studies has provided inconsistent results regarding
the association between SSc and atherosclerosis, highlighting the need
for further research on this field. In this article, we aim to review
current knowledge about large-vessel involvement and CVD in SSc and
discuss the potentially implicated pathogenetic mechanisms.SummarySSc
conveys a higher risk for CVD associated with both vascular and fibrotic
complications during the course of the disease. Increasing attention is
given on the use of vasodilators, immunosuppressants, and more recently
antifibrotic drugs that potentially improve myocardial function and
reduce atherosclerotic disease burden
Association Between Uric Acid and Worsening Peripheral Microangiopathy in Systemic Sclerosis
Objective: The key element in the pathogenesis of systemic sclerosis
(SSc) is microcirculatory changes in several vascular beds. Uric acid is
associated with endothelial dysfunction and therefore, microvascular
damage. The aim of this study was to examine the association between
uric acid (UA) and peripheral microvascular involvement in patients with
SSc.Methods: We included consecutive, consenting patients with SSc.
Serum UA, urea and creatinine were measured, and glomerular filtration
rate (GFR) was calculated with CKD-EPI. All participants underwent
nailfold video-capillaroscopy (NVC) to evaluate the
microcirculation.Results: A total of 64 patients (95.3% women) were
included in the study. UA levels were significantly associated with the
number of avascular areas (r = 0.290; p = 0.020), whereas no correlation
was shown for the GFR (r = -0.065; p = 0.609). A significant trend of UA
in the three capillaroscopic patterns was shown (3.90 +/- 1.52 vs. 4.15
+/- 0.98 vs. 5.38 +/- 2.26; for early, active, and late patterns
respectively, p = 0.028). Multivariate analysis showed that male gender
(beta = 3.049; 95% CI = 0.997-5.101) and UA (beta = 0.352; 95% CI =
0.117-0.588) were independently associated with the number of avascular
areas.Conclusion: These data suggest that UA levels are significantly
associated with the capillaroscopic patterns, reflecting a progressive
microvasculopathy
Subclinical atherosclerosis in systemic sclerosis and rheumatoid arthritis: a comparative matched-cohort study
Systemic autoimmune inflammatory disorders confer a higher risk of
cardiovascular (CV) disease leading to increased morbidity and mortality
and reduced life expectancy compared to the general population. CV risk
in systemic sclerosis (SSc) has not been studied extensively but
surrogate markers of atherosclerosis namely carotid intima media
thickness (cIMT) and pulse wave velocity (PWV) are impaired in some but
not all studies in SSc patients. The aim of this study was to
investigate the prevalence of subclinical atherosclerosis assessed by
cIMT and PWV between two well-characterized SSc and Rheumatoid Arthritis
(RA) cohorts. Consecutive SSc patients attending the Scleroderma Clinic
were compared with RA patients recruited in the Dudley Rheumatoid
Arthritis Co-morbidity Cohort (DRACCO), a prospective study examining CV
burden in RA. Augmentation Index (Aix75) and cIMT were measured in all
participants. Propensity score matching was utilised to select patients
from the two cohorts with similar demographic characteristics, CV risk
factors and inflammatory load. Unpaired analysis was performed using
unpairedttest for continuous variables and chi(2)test for dichotomous
variables. Statistical analysis was repeated using pairedttest for
continuous normal variables and McNemar’s test for dichotomous
variables. Fifty five age- and sex-matched SSc and RA patients were
included in the analysis. No difference was demonstrated between SSc and
RA subjects regarding cIMT (0.66 mm vs 0.63 mm, respectively) and
Aix75% measurements (33.4 vs 31.7, respectively) neither in paired (p =
0.623 for cIMT andp = 0.204 for Aix%) nor in unpairedttest analysis (p
= 0.137 for cIMT andp = 0.397 for AIx%). The results of this
comparative study show that subclinical atherosclerosis is comparable
between SSc and RA, a systemic disease with well-defined high
atherosclerotic burden. Such findings underscore the importance of CV
risk management in SSc in parallel with other disease-related
manifestations
Right Ventricular Morphology and Function after Exercise Training in People with Systemic Sclerosis: A Randomized Controlled Pilot Study
Background: Vascular dysfunction and its concomitant multi-organ involvement, including cardiac involvement, affects prognosis in systemic sclerosis (SSc) patients. Regular exercise has demonstrated to be able to improve vascular function in SSc. However, the effects of an exercise program on the heart and specifically in right ventricular (RV) morphology and function in SSc have yet to be explored. The study aimed to examine whether a 3-month combined exercise program can affect RV morphology and function in SSc patients. Methods: Twenty-eight SSc patients were randomly allocated to either the exercise training (ET) or the control (CON) group. Baseline and follow-up assessments consisted of a cardiopulmonary exercise test along with both a conventional and a two-dimensional speckle tracking echocardiography (2DSTE) focused on RV morphology and function. Following the baseline assessments, Group ET participated in a supervised combined exercise program for 12 weeks, while group CON received their usual care. Results: The ET group demonstrated increases in peak oxygen consumption by 25.1% (p p p p < 0.03) following the exercise program. No differences were observed in group CON. Conclusions: Combined exercise improved cardiorespiratory efficiency and indices of RV systolic function, as assessed by the 2DSTE, in SSc patients
Peripheral microcirculatory abnormalities are associated with cardiovascular risk in systemic sclerosis: a nailfold video capillaroscopy study
Introduction Microvascular dysfunction is the key element in the
pathogenesis of systemic sclerosis (SSc), whereas the contribution of
large and medium size vessel abnormalities is yet to be established. The
aim of the present study is to assess the association between micro- and
macrovascular function by utilizing a broad spectrum of assessments of
vascular performance. Methods We included consecutive, consenting SSc
patients who underwent nailfold video capillaroscopy (NVC) for
microcirculation evaluation. Peripheral and central systolic and
diastolic blood pressure, carotid intima-media thickness (cIMT), aortic
augmentation index (AIx) corrected for a heart rate of 75 beats per
minute (AIx-75), and carotid-femoral pulse wave velocity (PWV) were also
performed to assess macrovascular function. Cardiovascular risk disease
(CVD) algorithms were also calculated and included in the analysis.
Results A total of 81 patients (6 males) were studied with mean age
55.44 +/- 13.40 years. Reduced capillary density was inversely
correlated with arterial stiffness (Alx-75) and augmentation pressure (r
= - 0.262, p = 0.018, and r = - 0.249, p = 0.025 respectively). Alx was
significantly lower in the early compared to late pattern (28.24 +/-
11.75 vs 35.63 +/- 10.47, p = 0.036). A significant trend was found
among NVC patterns with Alx-75 values being higher with the progression
of microangiopathy towards the “late” group (26.36 +/- 10.90 vs
30.81 +/- 11.59 vs 35.21 +/- 7.90, p = 0.027 for trend). Similarly,
Framingham risk score and Atherosclerotic Cardiovascular Disease score
were progressively higher across the worsening NVC patterns (4.10 +/-
4.13 vs 2.99 +/- 2.72 vs 6.36 +/- 5.65, p = 0.023, and 6.99 +/- 7.18 vs
5.63 +/- 4.41 vs 12.09 +/- 9.90, p = 0.019, respectively, for trends).
Finally, QRISK3 (10-year cardiovascular disease risk) and ASCVD
(Atherosclerotic Cardiovascular Disease) scores were inversely
correlated with the number of capillaries (r = - 0.231, p = 0.048, and r
= - 0.260, p = 0.038 respectively). Conclusion These data suggest that
CVD risk scores and macrovascular parameters are strongly correlated
with microvasculopathy in patients with SSc