Vascular endothelial injury assessed with functional techniques in systemic sclerosis patients with pulmonary arterial hypertension versus systemic sclerosis patients without pulmonary arterial hypertension: a systematic review and meta-analysis

Abstract Microvascular dysfunction is one of the hallmarks of systemic sclerosis (SSc). The presence of pulmonary-arterial-hypertension (PAH) in SSc-patients is associated with poor prognosis. This is a systematic review and meta-analysis of studies assessing microvascular and endothelial injury with functional techniques in SSc-patients with PAH (SSc–PAH) compared to those without PAH (SSc–non-PAH) (PROSPERO: CRD42021236212). Literature search involved PubMed, the-Cochrane-Library, Web-of-Science, Scopus and manual search of article references. Studies assessing microvascular function by all available functional methods were considered eligible. Preclinical studies and studies using structural nailfold-videocapillaroscopy or biomarkers were excluded. Newcastle–Ottawa-Scale (NOS) was applied to evaluate the quality of retrieved studies. From a total of 602 retrieved articles, four studies (n = 159 participants) were included in meta-analysis; three studies were of high quality (NOS ≥ 7). In pooled analysis, a marginally significant impaired microvascular function was observed in SSc–PAH compared to SSc–non-PAH patients [SMD − 0.71, 95% CI (− 1.53, 0.12)], with significant between-study heterogeneity (I2 = 80%, p = 0.002). Among the studies examining endothelium-dependent and -independent vasodilation with LDF-iontophoresis, SSc–PAH subjects had significantly impaired endothelium-dependent-vasodilation [Ach-stimulated %change WMD − 216.79, 95% CI (− 337.87, − 95.71), I2 = 0%, p = 0.40], but no significant differences in endothelium-independent-vasodilation [SNP-stimulated %change WMD 90.84, 95% CI (− 82.52, 264.19), I2 = 44%, p = 0.18] compared with SSc–non-PAH subjects. In sensitivity analysis including only studies where SSc–PAH patients were diagnosed by right-heart-catheterization, a borderline difference between the two groups was noted [SMD − 1.09, 95% CI (− 2.30, 0.13), I2 = 82%, p = 0.004]. SSc–PAH patients showed marginally impaired microvascular function in the pooled analysis, as well as impaired endothelium-dependent-vasodilation in subgroup analysis compared with SSc–non-PAH patients. Vascular endothelial dysfunction could be involved in high cardiovascular risk of patients with SSc and PAH..

Medienart:	Artikel

Erscheinungsjahr:	2021
Erschienen:	2021

Enthalten in:	Zur Gesamtaufnahme - volume:41
Enthalten in:	Rheumatology international - 41(2021), 6 vom: 08. Apr., Seite 1045-1053

Sprache:	Englisch

Beteiligte Personen:	Theodorakopoulou, Marieta P. [VerfasserIn] Minopoulou, Ioanna [VerfasserIn] Sarafidis, Pantelis [VerfasserIn] Kamperidis, Vassilios [VerfasserIn] Papadopoulos, Christodoulos [VerfasserIn] Dimitroulas, Theodoros [VerfasserIn] Boutou, Afroditi K. [VerfasserIn]

Links:	Volltext [lizenzpflichtig]

Themen:	Endothelial dysfunction Functional methods Pulmonary arterial hypertension Systemic sclerosis

Anmerkungen:	© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021

doi:	10.1007/s00296-021-04850-2

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PPN (Katalog-ID):	OLC212515112X