FRI0343 EVALUATION OF CAROTID HEMODYNAMIC PARAMETERS AND PLAQUES BY DOPPLER ULTRASOUND IN PATIENTS WITH SYSTEMIC SCLEROSIS
Authors: Isidro Sanz Pérez, Fernando Martínez-Valle, Alfredo Guillén del Castillo, Olimpia Orozco-Galvez, Eduardo L. Callejas-Moraga, Vicent Fonollosa-Pla, Carmen Pilar Simeón-Aznar
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Carotid Doppler-ultrasound is useful for the detection of subclinical atheromatosis(1), and also for the evaluation of hemodynamic characteristics of carotid arteries(2). <h3>Objectives</h3> The aim of this study is to evaluate the hemodynamic parameters of carotid arteries and its relation with vascular related Systemic Sclerosis (SSc) complications and subclinical atheromatosis. <h3>Methods</h3> 157 patients with SSc of the cohort of Vall d'Hebron Hospital were included according to the ACR/EULAR 2013 criteria and LeRoy classification. The left and right common carotid arteries (CCA), bulb and internal carotid arteries (ICA) were scanned using Doppler ultrasound for the detection of plaques and for the measurement of the Peak Systolic Velocity (PSV), End Diastolic Velocity (EDV), Pulsatility Index (PI), Resistance Index (RI) and Systole/Diastole ratio (S/D), using the software incorporated in GE Healthcare's Vivid I equipment. <h3>Results</h3> 157 patients were included, 132 women (84.1%), the mean age was 56 years old (range 20-83) and the mean of years of disease evolution was 19 years (range 3-57). 64.2% were SSc limited subset, 20.9% SSc diffuse subset, 9.5% SSc <i>sine scleroderma</i> and 4.7% early SSc subset. 49.3% had digital ulcers, 41.9% had interstitial lung disease and 14.2% had pulmonary hypertension. There were no statistically significant differences in hemodynamic parameters in relation to Raynaud's phenomenon, digital ulcers or pulmonary hypertension. Seventy-five patients (47.7%) had carotid plaques. Patients with plaques had lower CCA PSV (66.8cm/s vs 76.7cm/s, p &lt;0.01, CI 4.62-14.5), lower CCA EDV (15.3 cm/s vs 19.99cm/s p &lt;0.01, CI 2.88-6.49), higher CCA PI (1.69 vs. 1.55, p &lt;0.05; CI 0.02-0.26) and higher CCA RI (0.77 vs 0.73 p &lt;0.01 CI 0.02-0.05). These patients also had lower ICA EDV (22.9cm/s vs 26.5cm/s, p &lt;0.01; CI 1.01-6.11), higher ICA PI (1.43 vs 1.32, p &lt;0.05 CI 0.01-0.22) and higher RI0.71 vs 0.68 p &lt;0,05 CI 0.01-0.05), without statistically significant differences in ICA PSV (79.75cm/s vs 84.24cm/s p: 0.21) nor in the ratio PSV/EDV. Ratio ICA PSV/CCA PSV was calculated, without showing significant differences in the presence of plaques or vascular manifestations of the SSc. The PSV greater than 120m/s, as an isolated measure, did not show statistically significant differences related to the presence of plaques. The PSV greater than 150 showed statistically significant differences (p &lt;0.01, CI 0.05-0.23), showing a large specificity 0.98 but a very low sensitivity 0.15 for the detection of plaques. <h3>Conclusion</h3> In our study we have not found relation between carotid hemodynamic parameters and microvascular related SSc complications such as Raynaud's phenomenon, the presence of digital ulcers or pulmonary hypertension. Patients with SSc and atheromatous disease have a characteristic carotid hemodynamic profile consisting in lower PSV and EDV, and higher PI and RI, both at CCA and at ICA. The presence of increased PI and RI in patients with plaques, could suggest a primary damage of the vascular wall in patients with SSc. More studies are needed to determine if these data are the cause or a consequence of the presence of plaques. In our study the PSV greater than 150 cm/s isolated shows a high specificity for the presence of plaques. <h3>References</h3> [1] Sanz Pérez I. et al. Subclinical cardiovascular disease and Systemic Sclerosis: A comparison between risk charts, quantification of coronary calcium and carotid ultrasonography. Autoimmun Rev. 2018;17(9):900–5. [2] Staub D. et al. Prediction of cardiovascular morbidity and mortality: Comparison of the internal carotid artery resistive index with the common carotid artery intima-media thickness. Stroke. 2006;37(3):800–5. <h3>Disclosure of Interests</h3> None declared