Background: Renal Resistive Index (RRI), reflects changes in both renal vascular and tubular-interstitial compartments and in systemic vascular compliance related to age and comorbidities. Objectives: a) To investigate determinants of RRI in SSc population, b) its association with SSc-related features and c) to test its prognostic impact on organ specific worsening or death. Methods: 380 SSc patients ≥18 years were enrolled after giving informed consent. Baseline data on RRI, laboratory, instrumental and therapeutic features were retrospectively collected. Age-SSc adjusted cut-offs were created by dividing the population in age quartiles and considering RRI values > 75th percentile as pathologic. Clinical follow-up was performed until last available visit or the development/worsening of specific internal organ involvement or death. Results: RRI was independently predicted by age and systolic pulmonary arterial pressure on Echo. Therefore, we created Age-SSc adjusted pathologic RRI cut-offs, which were significantly associated with various disease related skin and lung fibrotic manifestations, as well as vasculopathic complications. After a mean follow-up of 3.6 ± 2.6 years, RRI was one of the independent predictors (together with modified Rodnan skin score, interstitial lung disease, presence of dyspnoea and late nailfold-videocapillaroscopy pattern) for mortality, with 0.68 as best cut-off (sensitivity 88.5%, specificity 50.9%). Conclusion:If corroborated, Renal Resistive Index cut-offs might be used to evaluate renal and extrarenal involvement in SSc and could serve as predictors of mortality.

Objective The aim of the present retrospective observational study was to evaluate in SSc patients the change of renal resistive index (RRI) over the time (ΔRRI) and under treatment as well as to correlate these changes with disease complications. Methods 230 patients [29 male, median age 57 (48-67) years] were enrolled. At baseline and follow-up [3.43 (2.81-4.45) years] we collected following data: disease variables, nailfold videocapilloscopy (NVC) pattern, FVC (Forced vital capacity), carbon oxide diffusing capacity (DLCO), systolic pulmonary arterial pressure (sPAP), presence of interstitial lung disease, RRI, evaluation of glomerular filtration rate (eGFR), new onset of pulmonary arterial hypertension (PAH). Results RRI value is high in SSc patients with digital ulcers and ACA antibodies, active and late NVC patterns, lcSSc. A significant correlation was observed between ΔRRI and ΔsPAP (r=0.17, p=0.02), with statistically higher ΔRRI (0.08 ± 0.02 versus 0.03 ± 0.05, p=0.04) in patients complicated by PAH onset. No other new onset complication was associated with ΔRRI. The ROC curve analysis confirmed the predictive role of ΔRRI in development of new PAH (AUC 0.84; 95% CI 0.75-0.93, p=0.02). In SSc patients never exposed to sildenafil, ΔRRI was higher (0.04 ± 0.05) compared to both patients exposed to sildenafil during the study period (0.01±0.05, p=0.03) or in those exposed at the time of baseline evaluation (0.00 ± 0.05, p=0.01). Conclusion RRI and its variation in time are a reliable marker of SSc related vasculopathy, both in renal and extra-renal compartments.

BackgroundRenal Resistive Index (RRI- measured with Renal arteries Doppler ultrasound) is a useful technique to evaluate vascular and tubular-interstitial damage in both general and systemic sclerosis (SSc) population, where increased RRI values correlates with longer disease duration [1], lower glomerular filtration rate and more advanced nailfold-videocapillaroscopy pattern [2]. Moreover, higher RRI values were seen in SSc patients with new occurrence of digital ulcers [3].Objectivesto test the prognostic value of RRI [absolute, ≥0.70 and SSc age-adjusted pathologic value (Table1)] and RRI delta change in predicting general and organ-specific worsening in scleroderma patients.MethodsSSc patients classified according to ACR/EULAR 2013 criteria were enrolled. Demographics data and renal ultrasound data were collected. Data on clinical worsening had been collected as herewith specified: a) Skin worsening as an increase of mRSS≥5 units, b) Peripheral vascular worsening as the appearance of new digital ulcers or the worsening of nailfold videocapillaroscopy scleroderma pattern, c) Lung worsening as decline of FVC≥15% or FVC<80% with new detection of ILD on chest HRCT or worsening of HRCT-ILD extent, d) Cardiac worsening as new onset of left ventricular failure requiring treatments or new onset of PAH confirmed on RHC or detection of severe ventricular arrhythmias on 24h EKG, e) Renal worsening as a new scleroderma renal crisis or reduction of creatinine clearance ≤30 ml/min. General worsening was recorded in case of death due to SSc or for any of the above organ-specific worsening. Data were analysed as appropriate with SPSS vers. 20.0.Results190 SSc patients (age 56.3±15.0 yrs, 170 women, disease duration 6±8yrs, 65 with a follow up RRI measurement after 2.8±0.9 years) were enrolled. After a mean clinical follow-up of 3.6±2.6 years, 89 (46.8%) pts showed general worsening. Skin, peripheral vascular, cardiac, lung and renal worsening were detected in 14 (7.4%), 40 (21%), 32 (16.8%), 38 (20%) and 11 (5.8%) patients respectively. We registered 10 (5.2%) deaths and 43 (22.6%) patients with multiple organ worsening. Both absolute value of RRI and ≥0.70 RRI cut-off showed no significant association with organ or global clinical worsening, At the opposite, RRI cut-offs adjusted for age were associated with cardiac worsening (p=0.065 =- Figure 1). When in 65 patients the pattern of delta RRI and clinical worsening were analysed (Table 1), wider RRI changes were associated with general worsening (p=0.029) and cardiac worsening (p=0.006). The significance of these associations increased when sub-analyse was repeated focused on patients with normal SSc age-adjusted RRI values at baseline evaluation (p=0.017 and p<0.001 respectively, Figure 1).AgeProposed SSc age-adjusted pathologic cutoff 1st quartile, ≤48 years≥0,682nd quartile, 49–58 years≥0,693rd quartile, 59–67 years≥0,754th quartile, ≥68 years≥0,77Conclusionsincrease in RRI could be used as a sentinel sign for general and cardiac worsening in SSc patients, especially whe...

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BackgroundRRI can be measured on renal artery Doppler ultrasound, showing the difficulty blood flow encounters distally from where it is measured. RRI can be determined by vascular and interstitial renal features: studies on the general population showed arterial hypertension, arteriosclerosis, low-grade inflammation, diabetes mellitus, hyperuricaemia as possible causes of renal vasculopathy or tubular-interstitial nephropathy, thus determining altered RRI values. Studies on SSc have shown increased RRI values, associated with nailfold-videocapillaroscopy pattern and history of digital ulcers.Objectivesto identify determinants of RRI in SSc patients.MethodsSSc patients fulfilling the 2013 ACR/EULAR criteria were enrolled from two SSc-care units. Data regarding SSc clinical manifestations, instrumental and laboratory evaluation for renal, cardiac and cardiovascular involvement were collected. RRI was measured at least once in each patient. Linear regression analysis was carried out to determine predictors for baseline RRI and change in RRI in time (ΔRRI).Results380 patients [aged 57 (46-68) years, 12% males] were enrolled in the study. On univariate analysis, both general population determinants (age, arterial hypertension, diabetes mellitus, hyper-lipidaemia and hyper-uricaemia) and SSc specific features [time from Raynaud’s phenomenon onset, ACA positivity, scleroderma renal crisis history, estimates systolic pulmonary arterial pressure on Echo (sPAP), presence of dyspnea,%DLCO and presence of lower intestinal symptoms] predicted RRI values, with only age and sPAP being significant independent predictors at baseline. Follow-up RRI, available for 230 patients, showed that none of the general population determinants was predictive for ΔRRI, while presence of telangectasias, baseline FVC, use of Sildenafil, change in sPAP and new diagnosis of PAH were predictive at univariate regression. Among them, only presence of baseline telangectasias was an independent predictor of ΔRRI at multivariate regression analysis.ConclusionData show that among general population determinants, age is the only predictive factor for RRI in SSc patients. However, also sPAP (for RRI) and telangectasias could be predicitive for ΔRRI. Therefore, the use of specific age-adjusted cut-offs (table 1) are recommended when assessing SSc patients.Table 1Age-adjusted cut-offs for Renal Resistive Index (RRI) in Systemic sclerosis patients.Age (years)Age-SSc adjusted Pathologic RRI1st quartile ≤ 49 y≥0.682nd quartile 50-59 y≥0.703rd quartile 60-69 y≥0.754th quartile ≥70 y≥0.78Data show that among general population determinants, age is the only predictive factor for RRI in SSc patients. However, also sPAP (for RRI) and telangectasias could be predicitive for ΔRRI. Therefore, the use of specific age-adjusted cut-offs (table 1) are recommended when assessing SSc patients.Disclosure of InterestsCosimo Bruni: None declared, Edoardo Rosato: None declared, Antonietta Gigante: None declared, Vanessa Maestripieri: None declared, Giulia Tesei: None declared, M...