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Updated: Sep 10, 2025
A Methodological Approach to Non-invasive Assessments of Vascular Function and Morphology
Published on: February 7, 2015
Macrovascular Involvement in Systemic Sclerosis: Association Between Carotid Ultrasound Hemodynamics Parameters and
Eugenio Capparelli1,2, Francesco Lapia3, Luca Clerici3
1Rheumatology Unit, ASST Ovest Milanese, Legnano Hospital, Via Papa Giovanni Paolo II, Legnano, 20025 Milan, Italy.
Insights
Digital ulcers in scleroderma (SSc) patients are linked to significant changes in carotid artery blood flow and increased atherosclerosis. This suggests digital ulcers may indicate broader vascular issues beyond microvascular damage.
Area of Science:
- Vascular Medicine
- Rheumatology
- Cardiovascular Imaging
Background:
- Digital ulcers (DUs) are severe vascular complications in systemic sclerosis (SSc), often attributed to microvascular damage.
- Emerging evidence points to macrovascular abnormalities, including subclinical atherosclerosis and altered hemodynamics, as potential contributors to DUs in SSc.
Purpose of the Study:
- To investigate the association between a history of DUs and macrovascular involvement in SSc patients.
- To analyze carotid and vertebral Doppler ultrasonography findings, focusing on hemodynamic indices (Peak Systolic Velocity, End-Diastolic Velocity, Resistive Index) and Intima-Media Thickness.
Main Methods:
- A cross-sectional study involving 107 SSc patients.
- Collection of clinical, serological, cardiovascular, and metabolic data.
- Carotid-vertebral Doppler ultrasonography to assess hemodynamic parameters and Intima-Media Thickness, with patients stratified by DU history.
Main Results:
- SSc patients with a history of DUs exhibited significantly higher Peak Systolic Velocity (PSV) in both internal carotid arteries (ICA) and external carotid arteries.
- Elevated Resistive Index (RI) in the right ICA and a higher prevalence of carotid plaques were observed in the DU group.
- DU history independently predicted increased ICA PSV and the presence of carotid plaques.
Conclusions:
- A history of digital ulcers in SSc is associated with abnormal carotid hemodynamics and a greater burden of subclinical atherosclerosis.
- These findings indicate that DUs may signify underlying macrovascular dysfunction in addition to microvascular damage.
- An integrated vascular assessment approach is recommended for SSc patients to address both micro- and macrovascular complications.
Abstract:
Background: Digital ulcers (DUs) are among the most debilitating vascular complications in SSc and are commonly attributed to microvascular damage. However, recent evidence suggests a potential involvement of macrovascular abnormalities, including subclinical atherosclerosis and altered hemodynamic parameters. Objectives: This study aimed to investigate the association between a history of DUs and macrovascular involvement in SSc patients through carotid and vertebral Doppler ultrasonography, with a focus on hemodynamic indices such as Peak Systolic Velocity (PSV), End-Diastolic Velocity (EDV), Resistive Index (RI), and Intima-Media Thickness (IMT). Methods: A cross-sectional study was conducted on 107 SSc patients. Clinical, serological, cardiovascular, and metabolic data were collected, and carotid-vertebral ultrasound was performed. Patients were stratified based on DU history. Statistical analyses assessed associations between DU status and carotid-vertebral US findings. Results: Patients with DUs showed a significantly higher PSV in both right (86.9 ± 67.9 vs. 64.2 ± 20.5 cm/s, p = 0.010) and left ICA (78.9 ± 29.6 vs. 63.4 ± 18.2 cm/s, p = 0.002). Right ICA RI vas elevated in the DU group (p = 0.021). PSV in the external carotid arteries was also bilaterally increased in DU patients (p < 0.005). DU-positive patients had a higher prevalence of left carotid plaques (p = 0.012) and right-sided ICA RI > 0.75 (p = 0.01). Logistic regression identified DU history as an independent predictor of PSV at ICA (β = 31.89, p = 0.043) and carotid plaque presence at any side (OR 14.34, p = 0.012). Conclusions: A history of digital ulcers in SSc patients is associated with altered carotid hemodynamics and an increased subclinical atherosclerotic burden. These findings suggest that DUs may reflect not only microvascular damage, but also macrovascular dysfunction, supporting the need for integrated vascular assessment in SSc clinical practice.
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