Accelerated atherosclerosis in ANCA-associated vasculitis.

Area of Science:

• Vascular Medicine
• Neurology
• Rheumatology

Background:

• Cardiovascular disease is a leading cause of mortality in ANCA-associated vasculitis (AAV).
• AAV patients exhibit accelerated atherosclerosis beyond traditional cardiovascular risk factors.
• Cerebral small vessel disease is a concern in AAV.

Purpose of the Study:

• To investigate the association between atherosclerosis (measured by carotid intima-media thickness, CIMT) and cerebral small vessel disease in AAV patients.
• To explore the relationship between CIMT and various markers of small vessel disease in the brain.
• To determine if CIMT can serve as a predictor of microvascular brain injury in AAV.

Main Methods:

• Twenty-three AAV patients in remission underwent carotid ultrasonography (US), transcranial Doppler (TCD), brain MRI, and SPECT imaging.
• Carotid intima-media thickness (CIMT) was measured using US.
• Cerebral small vessel disease was assessed using TCD, MRI, and SPECT.

Main Results:

• AAV patients showed significantly higher CIMT compared to the normative population.
• Higher CIMT was associated with increased pulsatility index in the middle cerebral artery (PI-MCA), higher white matter lesion load on MRI, and abnormal SPECT findings.
• No association was found between higher CIMT and traditional cardiovascular risk factors like diabetes or hypertension.
• Increased internal carotid artery pulsatility index (PI-ICA) correlated with decreased mean flow velocity in the MCA (MFV-MCA) and increased white matter lesions on MRI.

Conclusions:

• The study confirms increased atherosclerosis in AAV patients.
• An association between CIMT and markers of cerebral small vessel disease (PI-MCA, ARWMC score, SPECT) was observed.
• Carotid US, measuring CIMT and PI-ICA, may be a valuable tool for predicting microvascular brain injury in AAV.