Background Both cardiovascular and complement-mediated disorders might lead to microvascular damages in anti-neutrophil cytoplasm autoantibodies (ANCA)-associated vasculitides (AAV). We aimed at investigating, for the first time, subclinical microvascular abnormalities with non-invasive techniques in AAV patients by analyzing both retinal and nailfold capillary changes. Retinal plexi were investigated using optical coherence tomography angiography (OCT-A), while nailfold capillary changes by video-capillaroscopy (NVC). Potential correlations between microvessels’ abnormalities and disease damage were also explored. Methods An observational study was conducted on consecutive patients who met the inclusion criteria of defined diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA), granulomatosis with polyangiitis (GPA), and microscopic polyangiitis (MPA), age ≥ 18 ≤ 75 yrs, and no ophthalmological disorders. Disease activity was assessed by Birmingham Vasculitis Activity Score (BVAS), damage by Vasculitis Damage Index (VDI), and poorer prognosis by the Five Factor Score (FFS). Quantitative analysis of vessel density (VD) was performed by OCT-A in both superficial and deep capillary plexi. Figures and detailed analysis from NVC were performed for all subjects in the study. Results Included AAV patients (n = 23) were compared with 20 age/sex-matched healthy controls (HC). Retinal VD in superficial whole and parafoveal plexi resulted significantly decreased in AAV compared to HC (P = 0.02 and P = 0.01, respectively). Furthermore, deep whole and parafoveal vessel density was strongly reduced in AAV than HC (P ≤ 0.0001 for both). In AAV patients, significant inverse correlations occurred between VDI and OCTA-VD in both superficial (parafoveal, P = 0.03) and deep plexi (whole, P = 0.003, and parafoveal P = 0.02). Non-specific NVC pattern abnormalities occurred in 82% of AAV patients with a similar prevalence (75%) in HC. In AAV, common abnormalities were edema and tortuosity in a comparable distribution with HC. Correlations between NVC changes and OCT-A abnormalities have not been described. Conclusion Subclinical microvascular retinal changes occur in patients with AAV and correlate with the disease-related damage. In this context, the OCT-A can represent a useful tool in the early detection of vascular damage. AAV patients present microvascular abnormalities at NVC, whose clinical relevance requires further studies.
BackgroundSystemic Lupus Erythematosus (SLE) patients have a 3- fold risk of CV events compared to the general population, mainly due to accelerated atherosclerosis that is not completely explained by the presence of traditional CV risk factors. Individuals with increased Intimal medial thickness (IMT) carry a higher risk to develop carotid atherosclerosis. Accordingly, IMT acts as a marker of subclinical atherosclerosis. In recent studies, SLE patients showed a significant higher IMT compared to healthy subjects. On the other side, SLE retinal involvement can be detected in 7-29% of cases, it is characterized mainly by retinal vasculopathy and it can be a marker of systemic vascular involvement. Optical Coherence Tomography Angiography (OCTA), a new diagnostic technique that can visualize retinal blood flow and evaluate the Fovea Avascular Zone (FAZ), has been investigated as an instrument for early detection of subclinical retinal vascular impairment in SLE.ObjectivesAim of this study is to examine a possible correlation between IMT and retinal vascular impairment assessed through OCTA in SLE.MethodsWe recruited SLE patients fulfilling 2019 EULAR/ACR classification criteria. Patients with other rheumatic, ophthalmological diseases, diabetes or history of CV diseases were excluded. We also collected patients’ demographic and clinical data, including sex, age, smoking habit, BMI, systolic and diastolic blood pressure (BP), C-Reactive Protein (CRP), total cholesterol, LDL, HDL, triglycerides. All patients underwent an ophthalmological evaluation, including OCTA estimation of superficial and deep retinal vessel density (VD), considering both the whole image and the foveal region, and FAZ area. Carotid ultrasound (US) comprising IMT assessment was also performed. Statistical analysis was accomplished using unpaired t-test or Mann Whitney U test, Pearson or Spearman rank correlation when appropriate.ResultsWe enrolled 37 SLE patients; demographic, clinical and US data are displayed in Table 1. Nine patients (24.3%) had uncontrolled arterial hypertension. According to US evaluation, carotid plaques were detected in six patients (16.2%). OCTA data were correlated with IMT values showing a negative correlation between IMT and both superficial and deep fovea VD (p=0.003, r=-0.4 and p=0.004, r=-0.4), while a positive correlation was found with FAZ area (p=0.02, r=0.4).Table 1.Demographic, clinical and US data of the study populationFemale sex n(%)28 (75.6)Age, yrs49.2±14.7Smokers n(%)12 (32.4)BMI25.1±5.2SBP, mmHg118.5±15.7DBP, mmHg73.3±11.6IMT, μM549.6±124IMT positively correlated with traditional CV risk factors, particularly age (p<0.0001, r=0.7), BMI (p=0.007, r=0.3) and systolic BP (p=0.001, r=0.4). Patients with high BP levels showed not only a significant higher IMT compared to the group with normal BP values (p=0.04), but also a significant increased FAZ area (p=0.02). FAZ area correlated positively with CRP levels (p=0.0001, r=0.5). Triglycerides showed a positive correlation with IMT values (p=0.001, r=0.4) and FAZ area (p=0.04, r=0.3) while correlated negatively with deep fovea VD (p=0.04, R=-0.4). A reduction in deep whole retinal VD was detected among patients with carotid plaques compared to the group without (p=0.02), together with higher IMT values (p=0.04).ConclusionRetinal vascular impairment in SLE has been associated with IMT, atherosclerotic plaques and some CV risk factors as hypertension, hypertriglyceridemia and CRP levels. Search for new markers of preclinical CV damage in SLE is currently ongoing and OCTA might be an additional instrument to assess preclinical cardiovascular involvement in SLE.Disclosure of InterestsNone declared
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