Oscillometric, greyscale- and novel color-Doppler-ultrasound indices of macrovascular damage in Sjögren’s: the SICARD cohort study

Abstract

Background: To assess for the first time a combination of oscillometric, greyscale- and novel color-Doppler ultrasound (US) indices of carotid and aortic damage in patients with primary Sjögren’s syndrome (pSS). Moreover, to examine associations of these markers with patient and disease-characteristics, as well as with a traditional cardiovascular (CV) risk score (SCORE) and its EULAR-modified version (mSCORE). Methods: Greyscale and color-Doppler indices [resistance (RI)- and pulsatility (PI)-index], as well as markers of atherosclerosis [Intima-Media-Thickness (cIMT), plaques, and cumulative calcification surface], were examined in the common- (CCA) and internal- (ICA) carotid arteries of pSS patients and healthy controls. The gold standard oscillometric marker of aortic stiffness (carotid-femoral pulse wave velocity; cfPWV) and the traditional SCORE/mSCORE, were also assessed. Results: We recruited 119 pSS-patients and 97 controls. Patients exhibited significantly higher cfPWV (padj = 0.025), cIMT (padj < 0.001), and calcification area (p = 0.013), compared to controls. According to mSCORE, 5.7% of the patients had high CV risk. However, cfPWV and carotid-sonography revealed increased aortic stiffness in 45.4% and carotid atherosclerosis in 69.2%, respectively. Among pSS-patients, cfPWV correlated with C-reactive-protein (rho = 0.325, p < 0.001), erythrocyte-sedimentation-rate (rho = 0.271, p = 0.003), and traditional CV-risk factors (age, cholesterol, systolic blood pressure: all; p < 0.01). ICA-RI and ICA-PI were higher in patients with further (non-rheumatological) autoimmune diseases (both; p < 0.05). Conclusion: In the largest cfPWV/US-cohort examined to date, pSS-patients had significantly higher aortic stiffness and atherosclerosis than controls. Aortic stiffness was predicted by systemic inflammation, alongside traditional CV risk factors. cfPWV and carotid-US may help identify subclinical end-organ disease and atherosclerosis and thus assist CV/CVB-screening in pSS. Trial registration: DRKS00031470.