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Autoimmun Rev. 2019 Feb;18(2):177-183. doi: 10.1016/j.autrev.2018.09.002. Epub 2018 Dec 18.

Nailfold avascular score and coronary microvascular dysfunction in systemic sclerosis: A newsworthy association.

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Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy.
Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
Clinical Cardiology, Department of Medical Science and Public Health, San Giovanni di Dio Hospital, University of Cagliari, Cagliari, Italy.
Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy. Electronic address:



We aimed to assess the relationship between nailfold videocapillaroscopy (NVC) abnormalities and coronary flow reserve (CFR), a marker of coronary microvascular dysfunction (CMD) in patients with systemic sclerosis (SSc).


We studied 39 SSc patients (33 females, mean ± SD age 54 ± 12 years, median disease duration 11 years, range 6-22) and 22 controls (matched for age and sex) without any evidence of cardiovascular disease. Clinical assessment was performed by modified Rodnan skin score (mRss) and EUSTAR score. Coronary flow velocities in the left anterior descending coronary artery were measured by transthoracic echocardiography. Average peak flow velocities, CFR and microvascular resistance at baseline (BMR) and in hyperaemic (HMR) condition were assessed. CFR ≤2.5 was considered marker of CMD. Six NVC-abnormalities were evaluated by a semi quantitative scoring system: enlarged and giant capillaries (diameter > 20 μm and >50 μm, respectively), hemorrhages, disarray, capillary ramifications and loss of capillaries (avascular score). Statistic was performed using SPSS.


CFR was lower in SSc patients than in controls (2.6 ± 0.5 vs 3.3 ± 0.5). CMD was detected in 24 patients (61.5%) vs 0 controls (p < .0001). CFR was inversely correlated with NVC-avascular score (rho =-0.750, p < .0001). Avascular and capillary ramifications scores (p = .001 and p = .03, respectively), mRss (p = .003) and EUSTAR score (p = .01) were higher in patients with CMD than in those without. At multivariable analysis, avascular score was independently associated with CMD (p = .01). HMR was directly correlated with avascular score (rho = 0.416, p = .008).


In our SSc patients NVC-avascular score was associated with CMD which seems to be the result of a structural microvascular remodeling.


Avascular score; Coronary flow reserve; Coronary microvascular dysfunction; Coronary microvascular resistance; Nailfold videocapillaroscopy; Systemic sclerosis

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