Rheumatology Advance Access originally published online on May 30, 2003
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Rheumatology 2003; 42: 1299-1305
© 2003 British Society for Rheumatology
Carotid and femoral arterial wall mechanics in scleroderma
Cardiovascular Haemodynamic Unit, University Department of Surgery, 1Centre for Rheumatology and 2University Department of Primary Care and Population Sciences, Royal Free and University College Medical School, University College London and The Royal Free Hospital, London NW3 2QG, UK.
Correspondence to:
A. M. Seifalian, University Department of Surgery, Royal Free and University College Medical School, UCL, Royal Free Hospital, Pond Street, London NW3 2QG, UK. E-mail: A.Seifalian{at}RFC.UCL.AC.UK
Objective. Large-vessel arterial disease is increasingly recognized as a major cause of morbidity in autoimmune rheumatic disorders. Recent evidence suggests that scleroderma (systemic sclerosis, SSc) may be linked to altered fibrillin-1 metabolism associated with a defect in chromosome 15q. If this is the case, we may expect to see changes in the arterial wall mechanics of large vessels not clinically involved in the disease process. We undertook a study to determine whether the biomechanical properties and intima–media thickness (IMT) of the elastic carotid artery and the muscular femoral artery are altered in subjects with limited (lcSSc) and diffuse (dcSSc) cutaneous SSc.
Methods. Measurements of carotid and femoral wall mechanics were made in 33 patients with lcSSc, 19 patients with dcSSc and 21 control subjects, using a duplex scanner coupled to a Wall Track system. Their age, gender, body mass index, heart rate, systolic and diastolic blood pressures, presumed cardiovascular load, and plasma creatinine, fasting cholesterol, triglyceride and glucose concentrations were also measured.
Results. There was a progressive and significant reduction (P < 0.001) in the elastic properties of the carotid artery from the control group (compliance, 16.24 ± 4.39 %mmHg–1 x 10–2) to the lcSSc group (10.89 ± 2.43 %mmHg–1 x 10–2) to the dcSSc group (7.65 ± 2.08 %mmHg–1 x 10–2), even after adjustment for the systemic physiological and biochemical variables studied, which are known to influence the mechanics of arterial walls. There was no apparent difference between the groups in the mean elastic indices of the femoral artery and the IMT of the carotid and femoral arteries.
Conclusion. The elastic properties of the carotid artery are significantly altered in SSc, and the two major subsets of SSc may be distinguished by their carotid artery biomechanics. This suggests that connective tissue abnormality occurs at sites not previously assessed.
KEY WORDS: Pathophysiology, Haemodynamics, Scleroderma, Limited cutaneous, Diffuse cutaneous, Systemic sclerosis, Carotid, Compliance, Stiffness.
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