PO:32:181 | Digital ulcers predict enhanced Peak Systolic Velocities at internal and external Carotid in Systemic Sclerosis Patients

Eugenio Capparelli¹, Francesco Lapia², Luca Clerici², Eleonora Zaccara¹, Giusy Cinzia Moltisanti², Francesca Capelli², Daniela Bompane¹, Paola Faggioli¹, Antonino Mazzone² | ¹UOC Reumatologia, ASST Ovest Milanese, Legnano, Milano, Italy; ²UOC Medicina Interna, ASST Ovest Milanese, Legnano, Milano, Italy

Background. The association between microangiopathy and macrovascular complications has been widely investigated in Systemic Sclerosis (SSc). Most of the studies focused on arterial stiffness or flow mediated dilatation, while, data regarding carotid peak systolic velocities (PSV) are lacking. The aim of this study was to compare ultrasonographic findings at vertebral-carotid levels in patients with a history of Digital Ulcers and to identify potential predictors of increased carotid flow other than common atherosclerotic risk factors.

Methods. We retrospectively analyzed a cohort of 107 SSc patients, stratified by the presence (n=31) or absence (n=76) of digital ulcers (DUs). Demographic, clinical, serological, cardiometabolic, and ultrasound data were compared between the two groups. Vascular assessment included carotid-vertebral ultrasound measurements of intima-media thickness (IMT), peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive indices (RI), alongside evaluation of carotid atherosclerotic plaques. Chi-square, T-student test and linear regression model were used for statistical analysis. P<0.05 was considered significant.

Results. Patients with a history of DUs were more frequently male (p<0.001), younger at diagnosis (p=0.041), and had higher modified Rodnan skin scores (p<0.001). The diffuse cutaneous subset was significantly more common in the DU group (p=0.001), as was the late capillaroscopic pattern (p=0.002). Serologically, anti-Scl70 positivity was more frequent in DU patients (p=0.001). Clinical features more prevalent among DU patients included pitting scars, sclerodactyly, calcinosis, upper gastrointestinal involvement, interstitial lung disease. (Table 1). As shown, in table 2, no differences in the most common risk factors for atherosclerosis were found between the two groups, who reported only an increased prevalence of hyperuricemia and angina pectoris, while exhibiting the same metabolic profile and blood pressure levels. From a vascular standpoint (Table 3), no differences were identified in EDV and IMT measures, while patients with DUs exhibited higher carotid blood flow velocities: PSV of the internal carotid artery (ICA) was significantly increased bilaterally (right: 86.9±67.9 vs 64.2±20.5 cm/s, p=0.01; left: 78.9±29.6 vs 63.4±18.2 cm/s, p=0.001), as was PSV in the external carotid artery (ECA) (right: 75.0±24.2 vs 87.7±25.3 cm/s, p=0.018; left: 71.7±20.1 vs 86.1±24.1 cm/s, p=0.002). The right ICA resistive index was also elevated (0.71±0.09 vs 0.67±0.07, p=0.022). Carotid plaque presence was significantly higher on the left side (51.6% vs 26.3%, p=0.012). The linear regression model reported that only digital ulcers were predictors of increased PSV at ICA level at both sides (p=0.035) , while no statistical significance was found for PSV at ECA level. (Fig.1).

Conclusions. These findings support the hypothesis of an increased vasculopathic burden at the carotid level in SSc patients with a history of DUs. The observed rise in PSV, particularly in distal carotid branches and in the absence of overt atherosclerosis, may reflect a functional macrovascular impairment in SSc.