PO:33:202 | Assessment of Retinal Arteriolar Wall-to-Lumen Ratio and Renal Resistive Index in patients with Systemic Sclerosis

Eleonora Pazzi^1|2, Elda Piovani^1|2, Claudia Barison^1|2, Liala Moschetti^1|2, Eleonora Pedretti^1|2, Mariagrazia Lazzaroni^1|2, Carolina De Ciuceis³, Claudia Agabiti-Rosei³, Giacomo Buso^3|4, Paolo Baggi³, Claudia Rossini³, Cristina Bevacqua³, Maria Lorenza Muiesan³, Ilaria Cavazzana¹, Franco Franceschini¹, Paolo Airò² | ¹Rheumatology and Clinical Immunology, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy; ²Scleroderma Unit, ASST Spedali Civili of Brescia, Brescia, Italy; ³Department of Clinical and Experimental Sciences, Division of Internal Medicine, ASST Spedali Civili of Brescia, Univers Brescia, Italy; ⁴University of Lausanne, Lausanne Switzerland

Abstract

Background. and Objectives Study of retinal arterioles by Adaptive Optics is a new tool, suggested to be useful in the evaluation of cardiovascular risk in the general population. In particular, a Wall-to-Lumen-Ratio (WLR) greater than 0.28 was demonstrated to predict reduced overall and cardiovascular event-free survival¹. Although the risk of cardiovascular mortality is 3.59 times higher in patients with systemic sclerosis (SSc) than in the general population², little information is available on retinal arterioles evaluation in SSc patients. The aim of the study was to address this issue, correlating retinal arterioles parameters with clinical and demographic parameters and signs of vascular disease evaluated by arterial Doppler Ultrasound (DUS).

Materials and Methods. Forty-one SSc patients were enrolled in this study. The following examinations were proposed to all patients: Non-invasive evaluation of retinal arterioles by Adaptive Optics. Kidney arteries DUS. Lower extremity arterial DUS. Statistical comparisons were performed using the Mann–Whitney U test, while correlations were evaluated using Spearman’s rank correlation coefficient (rs)

Results. Demographic and clinical features of included SSc patients are reported in Table 1. Completed assessments included: retinal WLR determination (n=24), kidney (n=28) and lower extremity DUS (n=25). Median WLR was 0.25 (0.23-0.27), with only 5 patients (21%) showing values greater than 0.28. Median renal resistivity index (RRI; normal values <0.70) was 0.74 (0.67-0.79) in the right kidney; 19 (68%) patients presented RRI over 0.70. DUS of the lower limbs showed the presence of peripheral arterial disease in 9 (36%) patients. No significant differences in WLR values were observed when stratifying the cohort by the analyzed parameters. RRI was increased in patients with arterial hypertension (p=0.0378) and in patients not treated with immunosuppressive therapy (p=0.047). Moreover, RRI showed a positive correlation with age (rs=0.40; p=0.032), disease duration (rs=0.39; p=0.041), and estimated PAPs on cardiac ultrasound (rs=0.50; p=0.012) (Fig. 1). No significant correlation emerged between WLR and RRI (rs=-0.10; p=0.689).

Conclusions. Retinal WLR was increased only in a relatively small number of SSc patients included in the study and does not appear to be associated with increased frequency of cardiovascular manifestations in this small cohort. The use of vasoactive drugs (calcium-channel blockers, ERA, IV prostanoids) and antiplatelet therapy in the large majority of the included patients might have affected these observations. On the other hand, kidney DUS demonstrates frequent arterial abnormalities. Further longitudinal studies on a larger number of patients with SSc may be warranted to evaluate the role of retinal arterioles and kidney arteries study in them. References 1. De Ciuceis, C. et al. European Journal of Internal Medicine, 122, 86 - 92. 2. Nathalie Conrad et al. Lancet 2022; 400: 733–43. Acknowledgements. The Authors thank GILS (Gruppo Italiano Lotta Sclerodermia) for substantially supporting this project.

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Keywords

• Microvascular
• Retina
• Kidney