Impaired Microcirculation and Vascular Hemodynamics in Relation to Macrocirculation in Patients With Systemic Lupus Erythematosus

Abstract

Introduction: Systemic lupus erythematosus (SLE) is associated with premature cardiovascular disease (CVD) and mortality, unexplained by traditional risk factors. Impairment of microcirculation and vascular hemodynamics may represent early signs of vascular affection. We hypothesized that studies of microcirculation and pulse waves may provide additional information, compared to ultrasound (US) alone, for the detection of early vascular disease in SLE.Methods: Sixty well-characterized SLE-patients (52 women, eight men; mean age 43.21 ± 1.3 years) characterized by lupus nephritis (LN; n = 20), antiphospholipid syndrome (APS; n = 20) or skin and joint involvement (n = 20) and 60 healthy controls were included. Microcirculatory peak oxygen saturation (OxyP) was evaluated using a novel combined laser Doppler flowmetry/diffuse reflectance spectroscopy method. Pulse waves were recorded in the radial artery by the aid of applanation tonometry in order to calculate central augmentation index (AIx75). Intima-media thickness (IMT) and plaque occurrence were evaluated using high frequency US, in carotid and central arteries.Results: Lower OxyP (84 ± 8 vs. 87 ± 5 %, p = 0.01) and higher AIx75 (17.3 ± 13.9 vs. 10.0 ± 14.2 %, p = 0.005) were seen in the SLE cohort. OxyP was inversely correlated with IMT in internal carotid artery (ICA), (R = −0.32, p = 0.01). AIx75 correlated with IMT in common carotid artery (CCA), (R = 0.36, p = 0.005), common femoral artery (CFA), (R = 0.43, p = 0.001), and ICA (R = 0.27, p = 0.04). AIx75 correlated negatively with OxyP (R = −0.29, p = 0.02). SLE-patients with plaque had lower OxyP values (80 ± 8 vs. 85 ± 7 %, p < 0.001) and higher AIx75 (23.0 ± 11.6 vs. 15.5 ± 14.2 %, p < 0.001) compared to those without plaque.Conclusion: Impaired microcirculation and vessel hemodynamics were observed in SLE. These methods correlated with IMT and plaque occurrence. The importance of early macro- and micro-circulatory vascular affection for increased risk of CVD in SLE will be followed-up in future studies.

Role of Altered Metabolism of Triglyceride-Rich Lipoprotein Particles in the Development of Vascular Dysfunction in Systemic Lupus Erythematosus

“…In a former study, Aix turned out to be related to organ damage measured by Systemic Lupus International Collaborative Clinics (SLICC) index in young women diagnosed with SLE without significant organ damage [ 16 ]. In another study, higher Aix was reported in a middle-aged SLE cohort, and Aix correlated with IMT in the common carotid artery, common femoral artery, and internal carotid artery [ 36 ]. A recent meta-analysis comprising 49 studies also showed increased Aix in patients with SLE compared to healthy controls [ 37 ], which may also underline the importance of measuring Aix.…”

Affected Microcirculation and Vascular Hemodynamics in Takayasu Arteritis

“…The system has been used to study microcirculatory perfusion in the Swedish Cardiopulmonary bioimage Study (SCAPIS), a large population-based cohort of men and women aged 50–65 years ( Jonasson et al, 2020 ). The method can differ between normal and disturbed microcirculatory flow in the skin ( Jonasson et al, 2017 ; Svensson et al, 2021 ; Jonasson et al, 2022 ), and the method has previously not been used in TAK.…”

“…Pulse wave analysis (PWA) was performed with applanation tonometry (SphygmoCor ® system, model MM3, AtCor Medical, Sydney, Australia) in both arms in TAK and in the right arm in controls. The procedure of the AIx measurements has been described previously ( Svensson et al, 2021 ). Augmentation index adjusted to heart rate 75 (AIx75) was calculated.…”

Cardiac and vascular complications in lupus: Is there a role for sex?

“…Nearly 10% of all patients with SLE have accelerated atherosclerosis development; inflammation in small, medium, and large vessels; and impaired endothelium-dependent relaxation compared with age-matched controls (3,(42)(43)(44)(45)(46). Multiple clinical studies implicate dyslipidemia and clotting factors in the association between CVD and SLE (5,43,47).…”