High-Frequency Ultrasound of Multiple Arterial Areas Reveals Increased Intima Media Thickness, Vessel Wall Appearance, and Atherosclerotic Plaques in Systemic Lupus Erythematosus

Abstract

Introduction: Despite improved therapies and management, patients with systemic lupus erythematosus (SLE) still have increased risks of cerebrovascular and cardiovascular disease. High-frequency ultrasound (US) provides an opportunity to distinguish atherosclerosis from inflammation in the vessels. We hypothesized that an extended US protocol may add information regarding vascular affection in SLE. Methods: Sixty patients (52 women, 8 men; mean age 43.2 ± 11.3 years) with SLE characterized by either lupus nephritis (LN; n = 20), antiphospholipid syndrome (APS; n = 20), or skin and joint involvement ( n = 20) as well as matched healthy controls ( n = 60) were included. Intima-media thickness (IMT), assessment of vessel walls, and plaque occurrence were recorded using high-frequency US (GE Logic E9) in common carotid, internal carotid, brachiocephalic, subclavian, axillary, common femoral, and proximal superficial femoral arteries as well as in the aortic arch. Results: For the entire SLE group, IMT was increased in the internal carotid artery (0.52 ± 0.17 vs. 0.45 ± 0.09 mm, p = 0.004), the common femoral artery (0.57 ± 0.23 vs. 0.49 ± 0.11 mm, p < 0.01), the subclavian artery (0.58 ± 0.19 vs. 0.53 ± 0.13 mm, p = 0.02), and the aortic arch (1.21 ± 0.63 vs. 0.98 ± 0.25 mm, p = 0.002) compared to controls. These differences were primarily observed in the APS and LN groups compared to controls. Vessels with increased IMT ≥0.9 mm had a smooth, medium echogenic appearance in areas free of atherosclerotic plaques. Atherosclerotic plaques were detected in 15/60 patients (25%) as compared to 2/60 of the controls (3%). Plaques were predominantly (67%) located in the carotid bifurcation. Multivariate analysis revealed influence of age on IMT in all vessel areas. Furthermore, in the common femoral artery, sagittal abdominal diameter, diastolic blood pressure, and cholesterol all showed association with increased IMT. In the internal carotid artery, male sex and presence of Raynaud phenomenon influenced IMT. Conclusion: Among SLE patients without presence of plaques, an extended US protocol revealed increased wall thickness with predominantly medium echogenic appearance highlighting possibly inflammation or early atherosclerosis. The appearance of vessel walls has not previously been studied in detail. An increased number of plaques were found in SLE compared to age- and sex-matched healthy controls. We found similar risk factors for increased IMT and occurrence of plaques, possibly indicating atherosclerotic mechanisms rather than inflammation.

Comparison of Surrogate Markers of the Type I Interferon Response and Their Ability to Mirror Disease Activity in Systemic Lupus Erythematosus

“…Another group of SLE patients originated from a cross-sectional sub-cohort of the register designed to examine cardiovascular involvement (“SLE-VASK”) ( 23 ). These patients ( n =59) had ≥1 year’s duration of SLE and available data on the IGS.…”

C-Reactive Protein Levels in Systemic Lupus Erythematosus Are Modulated by the Interferon Gene Signature and CRP Gene Polymorphism rs1205

“…The patients donated peripheral blood and the disease activity, defined by SLE disease activity index 2000 (SLEDAI-2K), was recorded from their closest regular visit to rheumatologist. All patients were considered to have low disease activity but could be serologically active and clinically quiescent at sampling ( 20 , 21 ). Each participant gave written informed consent, and the study protocol was approved by the regional ethics board in Linköping.…”

Plasma osteopontin versus intima media thickness of the common carotid arteries in well-characterised patients with systemic lupus erythematosus

“…23 We have recently shown that an extended HFUS protocol focused on multiple arterial areas may provide the clinician with additional information on the vessel wall appearance, in SLE subjects. 24 We recorded that increased IMT (!0.9 mm) observed in SLE predominantly showed appearance of a medium echogenic, homogenous wall thickening that can be found in inflammatory vascular disease. Concerning early wall changes in SLE, our results indicated other potential mechanisms apart from atherosclerosis.…”

“…Concerning early wall changes in SLE, our results indicated other potential mechanisms apart from atherosclerosis. 24 Herein, we aimed to investigate the reliability of pOPN as a surrogate biomarker of atherosclerosis in the common carotid arteries (CCA) of subjects with different SLE phenotypes i.e. in patients with either APS, or nephritis (LN), or isolated skin/joint involvement, as well as in matched control subjects.…”

“…Concerning early wall changes in SLE, our results indicated other potential mechanisms apart from atherosclerosis. 24 …”