Preferential macrovasculopathy in systemic sclerosis detected by regional pulse wave velocity from wave intensity analysis: comparisons of local and regional arterial stiffness parameters in cases and controls.
OBJECTIVE
To study the extent and severity of macrovasculopathy in systemic sclerosis (SSc; scleroderma) patients by comparing both local and regional arterial stiffness parameters.


METHODS
The local arterial stiffness indices of the right common carotid artery, right brachial artery, right radial artery, right superficial femoral artery, and right posterior tibial artery were measured in 25 SSc patients and strictly matched healthy controls. The regional pulse wave velocity (PWV) of each arterial segment was also calculated from wave intensity analysis.


RESULTS
There were no differences between the two groups in the stiffness index (β), Peterson's pressure modulus, arterial compliance, and local PWV derived from β (PWVβ) of all vessels except the right brachial artery, of which β, Peterson's pressure modulus, and PWVβ were markedly lower and arterial compliance was higher in SSc patients compared with controls (P<0.05). The forearm (brachial-radial) and arm (carotid-radial) PWVs were significantly higher in SSc patients than in controls (mean±SD 12.1±7.1 meters/second versus 8.3±3.5 meters/second and mean±SD 7.9±1.9 meters/second versus 6.9±1.5 meters/second, respectively; P<0.05), whereas the upper arm (carotid-brachial), aortic (carotid-femoral), and leg (femoral-ankle) PWVs were not different between groups. The aortic PWV was also higher in the diffuse cutaneous SSc subgroup than in controls (mean 6.2, 95% confidence interval [95% CI] 5.4-6.9 meters/second versus mean 5.1, 95% CI 4.7-5.6 meters/second; P<0.05) after adjusting for potentially influential variables.


CONCLUSION
The macrovasculopathy occurs preferentially at the forearm and aorta in SSc, which can be sensitively and reliably detected by regional PWVs rather than commonly used local arterial stiffness indices.