Left Ventricular Mass and Intrarenal Arterial Stiffness as Early Diagnostic Markers in Cardiorenal Syndrome Type 5 due to Systemic Sclerosis

Abstract

Background: Cardiorenal syndrome type 5 (CRS-5) includes a group of conditions characterized by a simultaneous involvement of the heart and kidney in the course of a systemic disease. Systemic sclerosis (SSc) is frequently involved in the etiology of acute and chronic CRS-5 among connective tissue diseases. In SSc patients, left ventricular mass (LVM) can be used as a marker of nutritional status and fibrosis, while altered intrarenal hemodynamic parameters are suggestive of early kidney involvement. Methods: Forty-two consecutive patients with a diagnosis of SSc without cardiac and/or renal impairment were enrolled to assess whether cardiac muscle mass can be related to arterial stiffness. Thirty subjects matched for age and sex were also enrolled as healthy controls (HC). All patients performed echocardiography and renal ultrasound. Results: Doppler indices of intrarenal stiffness and echocardiographic indices of LVM were significantly increased in SSc patients compared to HC. A positive correlation exists between LVM/body surface area and pulsatile index (p < 0.05, r = 0.36), resistive index (p < 0.05, r = 0.33) and systolic/diastolic ratio (p < 0.05, r = 0.38). Doppler indices of intrarenal stiffness and LVM indices were significantly higher in SSc patients with digital ulcers than in SSc patients without a digital ulcer history. Conclusions: SSc is characterized by the presence of microvascular and multiorgan injury. An early cardiac and renal impairment is very common. LVM and intrarenal arterial stiffness can be considered as early markers of CRS onset. The clinical use of these markers permits a prompt identification of organ damage. An early diagnosis allows the appropriate setting of pharmacological management, by slowing disease progression.

Prognostic Factors of Renal Involvement in Systemic Sclerosis

“…Arterial hypertension is a risk factor for the reduction of GFR. In SSc patients, intrarenal arterial stiffness is considered an early marker in course of SRC [23] and cardiorenal syndrome [24]. Recently, Rosato et al have demonstrated that RI are increased in SSc patients with anti-RNA polymerase III antibodies [25].…”

Cardiorenal syndrome in patients with rheumatoid arthritis

“…Наиболее часто КРС 5-го типа встречается при сепсисе, реже -при циррозе печени [12][13][14]. КСР у пациентов с аутоиммунными ревматическими болезнями описан в единичных обзорах и клинических наблюдениях, в которых в основном рассматриваются системная склеродермия и СКВ [15,16]. Эпидемиология, клинические особенности КРС и частота летальных исходов у больных РА не изучались.…”