Alterations in nailfold videocapillaroscopy among patients with connective tissue diseases combined with pulmonary arterial hypertension: A cross-sectional study

This study examines the correlation between nailfold videocapillaroscopy (NVC) abnormalities and pulmonary hypertension (PH) in connective tissue disease (CTD) patients, evaluating its diagnostic and predictive value for microcirculation alterations. A cross-sectional study included 351 CTD patients and 30 non-CTD healthy people, with NVC assessments conducted qualitatively, semi-quantitatively, and quantitatively by two independent physicians. Clinical and laboratory data were analyzed, comparing CTD patients with pulmonary arterial hypertension (CTD-PAH) and those without (CTD-non-PAH). Among the patients, 16.5% (n = 58) had pulmonary hypertension. CTD-PAH patients showed higher nailfold videocapillaroscopy scores (5.73 ± 3.54 vs. 4.30 ± 2.98, P = 0.001) and larger capillary diameters (17.06 ± 8.22 vs. 14.41 ± 9.25, P = 0.044) compared to CTD-non-PAH patients. Factors significantly influencing the nailfold videocapillaroscopy score included Raynaud's phenomenon, pulmonary hypertension, and the presence of anti-Scl-70 antibody. The ROC analysis yielded an AUC of 0.621 nailfold videocapillaroscopy score for predicting PAH. Additionally, pulmonary artery systolic pressure in CTD-PAH patients was positively correlated with both nailfold videocapillaroscopy score (R = 0.618, B = 3.26, P < 0.001) and capillary diameter (R = 0.541, B = 1.23, P < 0.001). Nailfold videocapillaroscopy abnormalities, such as higher scores and increased capillary diameters, are associated with pulmonary hypertension in patients with connective tissue diseases (CTD). This method demonstrates potential diagnostic and predictive value for detecting microcirculation alterations in these patients.