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Updated: Apr 28, 2026
Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research
Published on: October 22, 2014
Impaired endothelial function in patients with undifferentiated connective tissue disease: a follow-up study
Renata Laczik1, Pal Soltesz2, Peter Szodoray2
1Division of Clinical Immunology, Department of Internal Medicine, University of Debrecen Clinical Centre, Department of Immunology, University of Debrecen Clinical Centre, Hungary, Institute of Immunology, Rikshospitalet, University of Oslo, Oslo, Norway, Division of Rheumatology, Department of Internal Medicine, University of Debrecen Clinical Centre, Division of Metabolic Diseases, Department of Medicine, University of Debrecen Clinical Centre, Hungary and Department of Laboratory Medicine, Lahey Clinic, Boston, MA, USA Division of Clinical Immunology, Department of Internal Medicine, University of Debrecen Clinical Centre, Department of Immunology, University of Debrecen Clinical Centre, Hungary, Institute of Immunology, Rikshospitalet, University of Oslo, Oslo, Norway, Division of Rheumatology, Department of Internal Medicine, University of Debrecen Clinical Centre, Division of Metabolic Diseases, Department of Medicine, University of Debrecen Clinical Centre, Hungary and Department of Laboratory Medicine, Lahey Clinic, Boston, MA, USA.
Insights
Inflammation and autoantibodies in Undifferentiated Connective Tissue Disease (UCTD) patients cause endothelial cell injury, leading to atherosclerosis. Arterial stiffness markers like carotid intima-media thickness (IMT) and flow-mediated dilation (FMD) indicate preclinical disease.
Area of Science:
- Cardiovascular Medicine
- Rheumatology
- Immunology
Background:
- Undifferentiated Connective Tissue Disease (UCTD) is characterized by inflammation and autoantibodies.
- Endothelial dysfunction and arterial stiffness are potential early indicators of cardiovascular risk in UCTD.
Purpose of the Study:
- To investigate the alterations in endothelial function, arterial stiffness, and autoantibodies in UCTD patients.
- To assess the progression of these markers over time in UCTD.
Main Methods:
- A prospective study included 31 UCTD patients over an average 3.8-year follow-up.
- Measured flow-mediated vasodilation (FMD), carotid intima-media thickness (IMT), various autoantibodies, and endothelial markers (TM, ET-1, AECA).
Main Results:
- UCTD patients showed elevated hsCRP, TM, ET-1, and AECA compared to controls.
- Carotid IMT increased, and FMD deteriorated significantly during the follow-up period.
- Carotid IMT correlated with disease duration, TM, and anti-oxLDL levels in UCTD2 stage.
Conclusions:
- Inflammation and autoantibodies contribute to endothelial cell activation and injury in UCTD.
- Persistent endothelial dysfunction may lead to atherosclerosis development.
- FMD and IMT are sensitive markers for arterial stiffness and preclinical atherosclerosis in UCTD.
Objective:
In this study the alteration of endothelial function, arterial stiffness and autoantibodies was investigated in patients with UCTD.
Methods:
Thirty-one patients with UCTD were included in this prospective study. All the patients remained in the UCTD stage during the average 3.8 years follow-up period. The onset of UCTD was denoted as UCTD1, while the end of the follow-up period was called UCTD2. Flow-mediated vasodilation (FMD), carotid intima-media thickness (IMT), autoantibodies [such as anti-SSA, anti-SSB, anti-DNA, anti-RNP, anti-CCP, aCL, anti-oxidized low-density lipoprotein (oxLDL) and AECA], von Willebrand factor antigen, thrombomodulin (TM), endothelin 1 (ET-1) and lipid parameters were measured.
Results:
In the UCTD1 stage, high-sensitivity CRP (hsCRP) and endothelial cell activation and/or damage markers such as TM, ET-1 and AECA levels were significantly higher compared with controls (controls vs UCTD1: hsCRP, P < 0.0001; TM, P = 0.001; ET-1, P < 0.0001). In the UCTD2 stage, the carotid IMT increased (UCTD1 vs UCTD2, P = 0.01) and FMD further deteriorated (UCTD1 and UCTD2, P = 0.001). In UCTD2 there was a close correlation between the carotid IMT, and duration of the disease (r = 0.612, P < 0.001), the level of TM (r = 0.673, P < 0.001) and anti-oxLDL (r = 0.800, P < 0.001).
Conclusion:
Our data suggest that the presence of inflammation and autoantibodies provoke endothelial cell activation and/or injury in UCTD patients. The persistent endothelial dysfunction may provoke the development of atherosclerosis. FMD was found to be the most sensitive marker for arterial stiffness, and the increase of IMT clearly indicated the existence of preclinical atherosclerosis in UCTD patients.
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