Related Experiment Video
Updated: Apr 15, 2026
Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
Published on: June 16, 2020
Ischemic Vascular Complications in Early Systemic Sclerosis (SSc): A Longitudinal Inception Cohort Study of
Suparaporn Wangkaew1, Chammaliang Preecha1, Narawudt Prasertwitayakij2
1Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Insights
Ischemic vascular complications (IVCs) are uncommon in early systemic sclerosis (SSc) but increase mortality risk. Key predictors include digital ulcers, atrial fibrillation, and elevated pro-BNP levels.
Area of Science:
- Rheumatology
- Cardiology
- Vascular Medicine
Background:
- Early systemic sclerosis (SSc) patients face undefined risks for ischemic vascular complications (IVCs).
- Identifying predictors and outcomes of IVCs in early SSc is crucial for patient management.
Purpose of the Study:
- To determine the incidence, risk factors, and mortality associated with IVCs in early SSc.
- To identify specific predictors for coronary artery disease, ischemic stroke, and digital gangrene in this cohort.
Main Methods:
- An inception cohort of 146 early SSc patients was followed for a mean of 8 years.
- Clinical, laboratory, and cardiopulmonary data were collected at baseline and annually.
- Statistical analysis identified independent risk factors for IVCs and specific subtypes.
Main Results:
- IVCs occurred in 11.6% of patients, with digital gangrene being most common.
- Independent risk factors for IVCs included baseline digital ulcers, traumatic ulcers, LVEF < 50%, elevated pro-BNP, and atrial fibrillation.
- Patients with IVCs had significantly higher all-cause mortality.
Conclusions:
- IVCs are relatively uncommon in early SSc but significantly increase mortality risk.
- Baseline digital ulcers, traumatic ulcers, atrial fibrillation, impaired LVEF, and elevated pro-BNP are key indicators for increased IVC risk.
- Early identification of these risk factors can guide preventative strategies in early SSc management.
Abstract:
Background/Objectives: Predictors of ischemic vascular complications (IVCs)-including coronary artery disease (CAD), ischemic stroke, and digital gangrene-in patients with early SSc remain insufficiently defined. Therefore, we aim to determine the incidence, risk factors, and mortality associated with IVCs in early SSc. Methods: An inception cohort of patients with early SSc at the Rheumatology Clinic, Maharaj Nakorn Chiang Mai Hospital, Thailand, was studied from January 2010 to December 2023. Clinical, laboratory, and cardiopulmonary assessments were performed at baseline and annually thereafter. Results: A total of 146 patients (83 female, 119 DcSSc) were enrolled, with a mean disease duration of 11.5 ± 8.9 months from the first non-Raynaud's phenomenon (NRP). The mean follow-up was 8.0 ± 3.9 years. Seventeen patients (11.6%) developed IVCs, three CAD, four ischemic stroke, eight digital gangrene, and two digital gangrene plus CAD. The median time to first IVCs was two years. The overall incidence rate of IVCs from the NRP was 1.44 per 100 person-years (95% CI 0.89-2.32). Independent factors associated with IVCs included baseline (BL) digital ulcer, traumatic ulcer, LVEF < 50%, elevated pro-BNP, and any atrial fibrillation. BL pro-BNP and dyslipidemia were independently associated with CAD, whereas BL pro-BNP and any atrial fibrillation were associated with ischemic stroke. BL digital ulcer, traumatic ulcer, and any LVEF < 50% were associated with digital gangrene. All-cause mortality was higher among patients with IVCs than those without (9 [52.9%] vs. 37 [28.7], p = 0.043). Conclusions: In this study, IVCs were uncommon in early SSc, but were associated with increased mortality. Digital ulcers, traumatic ulcers, atrial fibrillation, impaired LVEF, and elevated pro-BNP identified the patients at higher risk of IVCs.
More Related Videos
13:07Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
Published on: January 15, 2022
05:07Author Spotlight: Improved Localization and Monitoring of Coronary Flow Reserve Using Modified PLAX View in Mice
Published on: August 25, 2023
Related Concept Videos
01:23Rheumatic Heart Disease I: Introduction
01:27Assessment of the Cardiovascular System III: Palpation
Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above...
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:30Atherosclerosis I: Introduction
01:25Endocarditis II: Clinical Features of Infective Endocarditis