Nailfold Capillaroscopy for Prediction of Novel Future Severe Organ Involvement in Systemic Sclerosis

Smith, Vanessa; Riccieri, Valeria; Pizzorni, Carmen; Decuman, Saskia; Deschepper, Ellen; Bonroy, Carolien; Sulli, Alberto; Piette, Yves; Keyser, Filip De; Cutolo, Maurizio

doi:10.3899/jrheum.130528

Cited by 129 publications

(146 citation statements)

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“…This may suggest that myocardial fibrosis may be related to CV follow-up of 18-24 months, the authors found a close relationship between worsening NVC grade, severe lung disease and peripheral vascular involvements. The same group confirmed these results in a larger and independent cohort 2 . In our study, we found a close relationship between NVC > grade 2 and the occurrence of CV events, strengthening the potential clinical value of NVC in CV risk stratification of SSc patients.…”

Section: Limitations Of the Studysupporting

confidence: 70%

“…Its importance to predict systemic organ involvement and peripheral vascular disease 2,20 was recently studied. Smith al.…”

Section: Nvc Grade and CV Eventsmentioning

confidence: 99%

“…The main lesion is characterized by a micro-vascular impairment leading to systemic fibrosis and in some severe cases to vital organs impairment 1 . Nailfold videocapillaroscopy (NVC) has emerged as an interesting tool to predict severe organ involvement such as lung fibrosis and skin ulcer 2,3 . However, NVC remains a poorly explored tool for the cardiovascular risk stratification in this population.…”

Section: Introductionmentioning

confidence: 99%

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Cardiovascular outcome in systemic sclerosis

et al. 2015

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Objectives Cardiovascular involvement is recognized as a poor prognostic factor in systemic sclerosis (SSc). The aim of this study was to evaluate the usefulness of nailfold video-capillaroscopy (NVC), brain natriuretic peptide (BNP) blood level and exercise echocardiography to predict the occurrence of cardiovascular events in SSc. MethodsWe prospectively enrolled 65 patients with SSc (age 54 ± 14 years, 30% female) followed in CHU Sart-Tilman, Liège, Belgium. All patients underwent graded semi-supine exercise echocardiography. Both baseline resting pulmonary hypertension (PH) and PH during follow-up (FUPH) were defi ned as systolic pulmonary arterial pressure (sPAP) > 35 mmHg, and exercise-induced PH (EIPH) as sPAP > 50 mmHg during exercise.Results EIPH was present in 21 patients. During FU (27 ± 18 months), 13 patients developed FUPH and 9 presented cardiovascular complications.Patients with cardiovascular events were signifi cantly older (63 ± 14 vs 52 ± 13 years; P = 0.03), presented more frequently NVC grade > 2 (89 vs 43%; P = 0.009), had higher resting and exercise sPAP (30 ± 6 vs 24 ± 6; P = 0.007 and 57 ± 13 vs 44 ± 13 vs mmHg; P = 0.01, respectively), and higher BNP blood level (112 ± 106 vs 26 ± 19 pg/ml; P = 0.0001). After adjustment for age and gender, NVC grade > 2 (ß = 2.4 ± 1.1; P = 0.03), EIPH (ß = 2.30 ± 1.13; P = 0.04), FUPH (ß = 0.24 ± 0.09; P = 0.01 and ß = 3.52 ± 1.16; P = 0.002, respectively;) and BNP (ß = 0.08 ± 0.04; P = 0.02) were independent predictors of CV events. Beyond age, an incremental value of EIPH, BNP and NVC grade > 2 was predictive of cardiovascular events (P < 0.001).Conclusion Cardiovascular complications are not rare in SSc (18%). NVC, BNP blood level assessment and exercise echocardiography could be useful tools to identify patients at risk of SSc. Keywords Systemic sclerosis -echocardiography -pulmonary hypertension -exercise -nailfold videocapillaroscopy -cardio-vascular diseases -brain natriuretic peptide.PH: pulmonary arterial hypertension; PVR: pulmonary vascular resistance; sPAP: systolic pulmonary arterial pressure; SSc: systemic sclerosis; SV: stroke volume.

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Section: Limitations Of the Studysupporting

confidence: 70%

“…Its importance to predict systemic organ involvement and peripheral vascular disease 2,20 was recently studied. Smith al.…”

Section: Nvc Grade and CV Eventsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cardiovascular outcome in systemic sclerosis

et al. 2015

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“…This study is the first to show an association between the number and size of CT with capillary loss and neoangiogenesis, 2 prominent features of the late NVC pattern, which is known to be the most severe, since the majority of SScrelated complications are observed in patients with this NVC pattern (14,15). In addition, the number and size of CT appear to be useful to identify a subgroup of patients at risk of severe SSc-related vasculopathy: patients with profuse CT more frequently exhibit digital ulcers, and patients with pseudotumoral CT also more commonly have precapillary PAH.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, some studies have shown that the late NVC pattern was predictive of the further development of severe peripheral vasculopathy and pulmonary vascular disease (14,20,21), and Sebastiani et al (22,23) showed that capillary loss, one of the main characteristics of the late NVC pattern, was the most relevant parameter to evaluate the risk of developing new digital ulcers of the capillaroscopic skin ulcer risk index formula.…”

Section: Discussionmentioning

confidence: 99%

Skin Telangiectasia and the Identification of a Subset of Systemic Sclerosis Patients With Severe Vascular Disease

Hurabielle

Avouac

Lepri

et al. 2016

Arthritis Care & Research

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Objective. Cutaneous telangiectasia (CT) are common in systemic sclerosis (SSc) patients, but their ability to stratify patients by risk is poorly known. We aimed to determine whether the number and size of CT were associated with the pattern of microvascular lesions assessed by nailfold videocapillaroscopy (NVC) and markers reflecting the severity of SSc-related vasculopathy.Methods. We performed a cross-sectional study, including consecutive SSc patients over a 6-month period. We also considered 3 predefined subsets of patients according to the number of hand or face CT: absence, £10, or >10 hand or face CT (profuse CT). Pseudotumoral CT were defined as CT with >5 mm diameter. Results. A total of 87 patients were included, of whom 75 (86%) had CT (27 with profuse and 19 with pseudotumoral CT). Profuse and pseudotumoral CT were both associated with capillary loss (P < 0.001 and P 5 0.002, respectively) and severe neoangiogenesis (P 5 0.015 and P 5 0.041, respectively), 2 hallmarks of the late NVC pattern. In multivariate analysis, profuse CT were independently associated with past or current digital ulcers (odds ratio [OR] 2.95 [95% confidence interval (95% CI) 1.09-19.63]), and pseudotumoral CT were independently associated with the late NVC pattern ) and with precapillary pulmonary hypertension . Conclusion. We demonstrate that the number and size of CT are associated with the most severe NVC pattern. In addition, profuse and pseudotumoral CT identify a subset of patients with a more severe vascular phenotype. Further prospective studies should determine whether CT number and size could serve as an early clinical biomarker for the development of severe vascular disease.

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