Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Virtual skin biopsy by Optical Coherence Tomography (OCT) has been proposed as quantitative outcome measure of fibrosis in Systemic Sclerosis (SSc). Dynamic OCT (D-OCT) is a newly developed technology that allows quantification of blood flow in vivo during OCT scans. Here we aimed to determine the validity of skin D-OCT as outcome measure of the skin microvascular disease, employing as comparator nailfold video-capillaroscopy (NVC) capillary patterns in SSc patients, and as clinical gold standard the presence of digital ulcers (DU).
Methods: One hundred and four subjects were enrolled in this study in 2 independent cohorts. In cohort 1 (Criterion Validity), 40 SSc patients fulfilling the ACR/EULAR 2013 criteria with different NVC pattern (10 for each normal/non- specific, early, active, ad late NVC pattern) and 10 healthy volunteers (HV), underwent nailfold D-OCT. In cohort 2 (Face/Content Validity) 36 SSc patients with (18) or without (18) DU and 18 patients with Raynaud’s phenomenon (RP) and SSc specific ANA, who did not fulfill ACR/EULAR 2013 criteria (SRP group) underwent D-OCT of index and middle fingers on the proximal phalanx. Microvascular flow (MVF) was analyzed using the proprietary software from Michelson Diagnostics Ltd.
Nailfold D-OCT allowed visualization of the corresponding SSc patterns seen at NVC. Furthermore, within D-OCT images, MVF measurements were significantly different between HV and SSc patients with any specific capillary pattern (0.16±0.02 vs 0.10±0.01,p=0.0028) and between SSc patients without and with specific capillary pattern (0.14±0.01 vs 0.10±0.01,p=0.02). Concordantly, MVF was significantly lower in patients displaying capillary loss as main feature compared with those with remarkable angiogenesis (p=0.03). Skin D-OCT showed a median MVF significantly different among the 3 groups: 0.134 (DU) vs 0.153 (no DU) vs 0.167 (SRP) (p<0.0001), and in the DU vs no DU (p<0.001) or vs SRP (p<0.001). Further, DU patients on Sildenafil (n=6) had a significantly higher MVF than DU patients on no Sildenafil (p<0.01).
Conclusion: MVF assessed by D-OCT shows face/content and criterion validity as biomarker of skin microvascular disease in SSc. Future longitudinal studies are needed to evaluate its sensitivity to change over time.
To cite this abstract in AMA style:Abignano G, Daniel A, Green L, Eng S, Emery P, Del Galdo F. Microvascular Flow Assessed By Dynamic Optical Coherence Tomography: First Non-Invasive Quantitative Outcome Measure of Microvascular Disease in Systemic Sclerosis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). http://acrabstracts.org/abstract/microvascular-flow-assessed-by-dynamic-optical-coherence-tomography-first-non-invasive-quantitative-outcome-measure-of-microvascular-disease-in-systemic-sclerosis/. Accessed November 22, 2017.
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ACR Meeting Abstracts - http://acrabstracts.org/abstract/microvascular-flow-assessed-by-dynamic-optical-coherence-tomography-first-non-invasive-quantitative-outcome-measure-of-microvascular-disease-in-systemic-sclerosis/