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Ultrasound evaluation of bowel vasculopathy in systemic sclerosis

  • Author Footnotes
    1 These authors contributed equally to this work.
    Giulia Bandini
    Correspondence
    Corresponding author at: Department of Experimental and Clinical Medicine, University of Florence, and Division of Internal Medicine AOUC, Viale San Luca, Florence 50134, Italy.
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Experimental and Clinical Medicine, University of Florence, and Division of Internal Medicine AOUC, Viale San Luca, Florence 50134, Italy

    Institute of Clinical Physiology, National Research Council, Pisa, Italy

    Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Laura Cometi
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy

    Institute of Clinical Physiology, National Research Council, Pisa, Italy

    Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
    Search for articles by this author
  • Esterita Accogli
    Affiliations
    Department of Internal Medicine, Centre of Research and Learning in Ultrasound, Maggiore Hospital, Bologna, Italy

    Institute of Clinical Physiology, National Research Council, Pisa, Italy

    Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
    Search for articles by this author
  • Andrea Domanico
    Affiliations
    Department of Internal Medicine, Centre of Research and Learning in Ultrasound, Maggiore Hospital, Bologna, Italy

    Institute of Clinical Physiology, National Research Council, Pisa, Italy

    Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
    Search for articles by this author
  • Lorenzo Tofani
    Affiliations
    Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy

    Institute of Clinical Physiology, National Research Council, Pisa, Italy

    Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
    Search for articles by this author
  • Cosimo Bruni
    Affiliations
    Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy

    Institute of Clinical Physiology, National Research Council, Pisa, Italy

    Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
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  • Silvia Bellando-Randone
    Affiliations
    Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy

    Institute of Clinical Physiology, National Research Council, Pisa, Italy

    Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
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  • Gemma Lepri
    Affiliations
    Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy

    Institute of Clinical Physiology, National Research Council, Pisa, Italy

    Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
    Search for articles by this author
  • Martina Orlandi
    Affiliations
    Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy

    Institute of Clinical Physiology, National Research Council, Pisa, Italy

    Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
    Search for articles by this author
  • Serena Guiducci
    Affiliations
    Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy

    Institute of Clinical Physiology, National Research Council, Pisa, Italy

    Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
    Search for articles by this author
  • Khadija El-Aoufy
    Affiliations
    Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy

    Institute of Clinical Physiology, National Research Council, Pisa, Italy

    Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
    Search for articles by this author
  • Gabriele Ciuti
    Affiliations
    Department of Experimental and Clinical Medicine, University of Florence, and Division of Internal Medicine AOUC, Viale San Luca, Florence 50134, Italy

    Institute of Clinical Physiology, National Research Council, Pisa, Italy

    Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
    Search for articles by this author
  • Alessia Fabbri
    Affiliations
    Department of Experimental and Clinical Medicine, University of Florence, and Division of Internal Medicine AOUC, Viale San Luca, Florence 50134, Italy

    Institute of Clinical Physiology, National Research Council, Pisa, Italy

    Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
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  • Marco Matucci-Cerinic
    Affiliations
    Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy

    Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy

    Institute of Clinical Physiology, National Research Council, Pisa, Italy

    Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
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  • Alberto Moggi-Pignone
    Affiliations
    Department of Experimental and Clinical Medicine, University of Florence, and Division of Internal Medicine AOUC, Viale San Luca, Florence 50134, Italy

    Institute of Clinical Physiology, National Research Council, Pisa, Italy

    Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
    Search for articles by this author
  • on behalf of theStudy Group of Rheumathology and Internal Medicine
  • Author Footnotes
    1 These authors contributed equally to this work.
Published:January 17, 2022DOI:https://doi.org/10.1016/j.ejim.2022.01.026

      Highlights

      • Very little is available for early screening and diagnosis of bowel vasculopathy in SSc.
      • CDU can demonstrate impedance and elasticity impairment of splanchnic vessels in SSc.
      • SMA and IMA CDU may support a therapeutic approach targeted on early SSc involvement of splanchnic circulation.

      Abstract

      Background

      Gastrointestinal (GI) manifestations are frequent in systemic sclerosis (SSc) with an impact on quality of life and morbidity. Bowel vasculopathy is a key pathogenetic factor responsible for GI involvement.

      Objectives

      To compare abdominal ultrasound (US) and Color Doppler Ultrasonography (CDU) features of splanchnic vessels of SSc patients with healthy controls.

      Methods

      The charts of SSc patients who underwent an abdominal US and CDU study were retrospectively analyzed. For Superior Mesenteric Artery (SMA) and Inferior Mesenteric Artery (IMA) caliber, Peak Systolic Velocity (PSV), Reverse Velocity (RV), End-Diastolic Velocity (EDV), Mean Velocity (mV), Blood-flow, Resistive Index (RI) and Pulsatility Index (PI) were recorded.

      Results

      28 SSc patients and 28 controls were enrolled. In SSc, caliber of SMA was significantly smaller than in controls (5.75 ± 0.62 mm vs. 6.45 ± 0.60 mm, p < 0.0001 – p adj =0.0002). The flow study of SMA and IMA showed a significant reduction of RV (SMA: 7.25 ± 6.37 cm/s vs. 18.52 ± 6.16 cm/s, p < 0.0001 - p adj <0.0001; IMA: 2.69 ± 6.10 cm/s vs. 17.06 ± 5.75 cm/s, p < 0.0001 - p adj <0.0001) and PI (SMA: 3.33 ± 0.75 vs. 4.53 ± 1.03, p < 0.0001 - p adj =0.0002; IMA: 3.54 ± 0.95 vs. 6.08 ± 1.53, p < 0.0001 - p adj <0.0001) in SSc patients than controls.

      Conclusion

      involvement of splanchnic vessels in SSc may be non-invasively investigated with abdominal US and CDU. Morphological and functional changes of Doppler parameters observed in SMA and IMA clearly demonstrate that these vessels are affected by SSc vasculopathy.

      Keywords

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