Background/Purpose: Microangiopathy predominates in the pathophysiology of Systemic Sclerosis (SSc). However, large vessel involvement leading to higher risk for cardiovascular disease in SSc remains unclear. Nailfold videocapillaroscopy (NVC) is an established method for the assessment of the microvasculature, aiding in distinguishing different types of structural vascular abnormalities. Until recently, NVC was used in the diagnosis of SSc as well as in the assessment and follow-up of peripheral digital vasculopathy however recent data indicates a possible association with macrovascular involvement namely atherosclerosis and coronary artery disease. The aim of this study was the investigation of the relation between microvascular and macrovascular involvement in the setting of SSc.

Methods: Consecutive patients with established SSc treated in the Scleroderma Clinic of State Hospital Unit from September 2016 until June 2017 were enrolled in our study. We conducted NVC to evaluate microcirculation. The number of capillaries/mm² and capillarosscopic index CSURI were measured. Findings were also classified to the three scleroderma patterns (early, active, and late). Cardiovascular risk was assessed using the European SCORE, while the following vascular markers were measured: carotid intima-media thickness (IMT), Augmentation Index (AIx) of the aorta, aortic pulse wave velocity (PWV) and central systolic and diastolic blood pressure. The correlation between microvascular and macro-vascular parameters was examined.  

Results: Thirty-seven (1 man) SSc individuals were studied. Among the atherosclerotic morphological and functional parameters assessed, a significant correlation was observed between aortic AIx and the average number of capillaries/mm² (r = -0.34, p = 0.047) and between AIx and the capillary index CSURI (r = 0.35, p = 0.044). In addition, lower AIx values were recorded in the “early” scleroderma pattern compared to the “active” and “late” pattern [20.5 ± 11.4 vs 34.1 ± 11.5%, p = 0.02 (early vs. active) and 20.5 ±11.4 vs 33.4 ± 8.8%, p = 0.05 (early vs late)]. No statistically significant associations were demonstrated between abnormalities of nailfold capillaries and IMT, PWV or SCORE in our population.

Conclusion: The extent of microangiopathy is related to the degree of arterial stiffness assessed by Alx suggesting a potential link between micro- and macrovascular disease in SSc.