Colour Doppler ultrasound assessment of retrobulbar hemodynamics and static retinal vessel analysis in Sjögren’s disease: the SICARD cohort

Abstract Objectives To assess, for the first time, macrovascular, medium-calibre vessel, and microvascular damage in Sjögren’s disease (SjD) using carotid greyscale ultrasound (GSUS), retrobulbar colour Doppler ophthalmic artery (OA) ultrasound (RCDUS), and static retinal vessel analysis (SRVA). Additionally, to evaluate associations of these markers with cardiovascular (CV) risk factors, patient- and disease-related characteristics. Methods GSUS of the common carotid arteries was performed to measure carotid intima-media thickness (cIMT) and evaluate plaque burden. RCDUS assessed OA flow velocity integral (FVI), resistive, and pulsatility indices (RI, PI). SRVA quantified retinal microvasculature using central retinal arteriolar, venular equivalents (CRAE, CRVE), and the arteriovenous ratio (AVR). Imaging findings were compared between patients with SjD and healthy controls and analysed in relation to clinical parameters. Results 130 SjD patients and 100 controls were included. SjD patients showed significantly higher cIMT (padj=0.003), OA-RI (padj=0.003) and -PI (padj<0.001), as well as lower OA-FVI (padj=0.012) and CRAE (padj=0.013) compared with controls. Higher OA-RI and -PI correlated with higher disease activity (ESSDAI: both; rho=0.324, p = 0.006), and impaired renal function (rho=-0.461, p < 0.001 and rho=-0.370, p = 0.002, respectively). OA-RI associated positively with age (rho=0.435, p < 0.001) and inversely with lung carbon monoxide diffusion (r=-0.342, p = 0.019). Lower CRAE correlated with higher mean arterial pressure (r =-0.378, p < 0.001), CRP (rho= -0.215, p = 0.046), ANA titre (rho=-0.268, p = 0.016), and disease activity (ESSDAI: rho=-0.273, p = 0.011). Conclusions In this first comprehensive study of CV surrogate markers in SjD, patients exhibited vascular alterations across multiple vascular beds, indicating systemic vascular involvement and a possible link to increased cardiovascular and cerebrovascular risk.