on July 27, 2006
Published online before print July 27, 2006, doi: 10.1161/01.ATV.0000238351.82900.7f
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Submitted on February 27, 2006
Accepted on July 11, 2006
Microcirculatory Hemodynamics and Endothelial Dysfunction in Systemic Lupus Erythematosus
Stephen A. Wright *;
From the Department of Therapeutics and Pharmacology (S.A.W., F.M.O., R.D.P., W.J.L., A.B.D., D.G.J., G.E.M.), Queens University Belfast, Northern Ireland; Lupus Research Group (S.A.W., A.L.B.), Queens University Belfast; Northern Ireland Medical Physics Agency (D.J.R., A.J.G., C.M.), Belfast; Department of Rheumatology (M.B.F.), Royal Group of Hospitals, Belfast
* To whom correspondence should be addressed. E-mail: s.wright{at}qub.ac.uk.
Objective--Impaired flow-mediated dilation (FMD) occurs in disease states associated with atherosclerosis, including SLE. The primary hemodynamic determinant of FMD is wall shear stress, which is critically dependent on the forearm microcirculation. We explored the relationship between FMD, diastolic shear stress (DSS), and the forearm microcirculation in 32 patients with SLE and 19 controls.
Methods and Results--DSS was calculated using (mean diastolic velocity x 8 x blood viscosity)/baseline brachial artery diameter. Doppler velocity envelopes from the first 15 seconds of reactive hyperemia were analyzed for resistive index (RI), and interrogated in the frequency domain to assess forearm microvascular hemodynamics. FMD was significantly impaired in SLE patients (median, 2.4%; range, -2.1% to 10.7% versus median 5.8%; range, 1.9% to 14%; P<0.001). DSS (dyne/cm2) was significantly reduced in SLE patients (median, 18.5; range, 3.9 to 34.0 versus median 21.8; range, 14.1 to 58.7; P=0.037). A strong correlation between FMD and DSS, rs=0.65, P=0.01 was found. Postischemic RI was not significantly different between the 2 groups; however, there were significant differences in the power-frequency spectrums of the Doppler velocity envelopes (P<0.05).
Conclusions--These data suggest that in SLE, altered structure and function of the forearm microcirculation contributes to impaired FMD through a reduction in shear stress stimulus.
Key words: eigenvector • flow-mediated dilation • microcirculation • shear stress • systemic lupus erythematosus
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