ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2592

Clinical Significance Of Endothelial Vasodilator Function Evaluated By Endopat In Patients With Systemic Sclerosis

Naohiko Aozasa1, Yoshihide Asano1, Masaru Hatano2, Ryosuke Saigusa1, Kouta Takakuwa1, Takehiro Takahashi1, Tetsuo Toyama1, Hayakazu Sumida1, Atsushi Yao3, Koichiro Kinugawa4, Hisataka Maki2, Toshiro Inaba2, Hironori Muraoka2, Shun Minatsuki2, Issei Komuro2 and Shinichi Sato1, 1Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan, 2Cardiovascular Medicine, University of Tokyo Graduate School of Medicine, Tokyo, Japan, 3Division for Health Service Promotion, University of Tokyo Graduate School of Medicine, Tokyo, Japan, 4Department of Therapeutic strategy for heart failure, University of Tokyo Graduate School of Medicine, Tokyo, Japan

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords:

Session Information

Title: Systemic Sclerosis, Fibrosing Syndromes, and Raynaud’s - Clinical Aspects and Therapeutics II

Session Type: Abstract Submissions (ACR)

Background/Purpose: Systemic sclerosis (SSc) is a multisystem autoimmune disease characterized by initial vascular injuries and resultant fibrosis of skin and certain internal organs. Evidence has shown that vascular impairment in SSc may be a sign of endothelial dysfunction. The peripheral arterial tonometry (EndoPAT) is a device that is used to assess endothelial vasodilator function in a rapid and non-invasive fashion. Since its clinical significance has not been well established in SSc, we evaluated the association between the values of reactive hyperemia measured by EndoPAT and clinical features of SSc.

Methods: Thirty-three consecutive patients with SSc were studied, including 15 patients with limited cutaneous SSc (lcSSc) and 18 with diffuse cutaneous SSc (dcSSc). Clinical symptoms, such as swollen fingers, nailfold bleeding (NFB), pitting scars, digital ulcers, and Raynaud’s phenomenon, were meticulously recorded. Reactive hyperemia peripheral arterial tonometry index (RHI) was measured using EndoPAT on all patients. Mean pulmonary artery pressure (mPAP) was measured by right heart catheterization. Correlations of RHI with various clinical symptoms, disease duration, laboratory data and disease subtypes were examined.

Results: RHI values were inversely correlated with mPAP (r = -0.47, p < 0.01), while positively correlated with %DLco (r = 0.35, p < 0.05). Furthermore, the values of RHI inversely correlated with disease duration in dcSSc patients (r = -0.45, p < 0.05), but not in lcSSc patients. Of note, RHI values were increased after one month of oral prednisolone in 4 patients with progressive skin sclerosis in whom skin stiffness was improved in response to the treatment.

Conclusion: Although mPAPs of all the patients enrolled in this study were less than 25 mmHg, the values of RHI were significantly and inversely correlated with mPAP, suggesting that the decreased RHI value reflects the reduction of the pulmonary vascular bed prior to the development of definite pulmonary arterial hypertension in SSc. Since skin sclerosis may affect the values of RHI, we have to be cautious to interpret the impact of prednisolone on endothelial function evaluated by EndoPAT in this disease.

Disclosure:

N. Aozasa,
None;

Y. Asano,
None;

M. Hatano,
None;

R. Saigusa,
None;

K. Takakuwa,
None;

T. Takahashi,
None;

T. Toyama,
None;

H. Sumida,
None;

A. Yao,
None;

K. Kinugawa,
None;

H. Maki,
None;

T. Inaba,
None;

H. Muraoka,
None;

S. Minatsuki,
None;

I. Komuro,
None;

S. Sato,
None.

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