Myocardial Perfusion Is Reduced in Raynaud’s Syndrome
Raynaud’s syndrome (RS) is a medical condition in which there are episodes of reduced blood flow due to spasm of arteries. RS is common among young women (primary) and can occur secondary to a wide variety of other conditions including connective tissue disorders. Typically the fingers, and less commonly the toes, are involved.
Similar to peripheral spasm, myocardium can also suffer from a reduced perfusion in a population of RS (either primary or secondary), showed a recent study. Myocardial perfusion was assessed, using adenosine stress cardiovascular magnetic resonance (CMR).
Patients and methods
Twenty CTDs, aged 30.6±7.5yrs., 16F/4M, including 9 systemic sclerosis (SSc), 4 systemic lupus erythematosus (SLE), 3 mixed connective tissue disease (MCTD), 2 polymyositis (PM) and 2 rheumatoid arthritis (RA), with secondary RS, under treatment with calcium blockers, were evaluated by stress CMR and compared with age-sex matched primary RS and controls.
All RS patients were under treatment with calcium blockers.
Stress perfusion CMR was performed by 1.5T system using 140mg/kg/min adenosine for 4min and 0.05mmol/kg Gd-DTPA for first-pass perfusion. A rest perfusion was performed with the same protocol. Late gadolinium enhanced (LGE) images were acquired after another dose of Gd-DTPA.
Results
In both primary and secondary RS groups the myocardial perfusion reserve index (MPRI) was significantly reduced compared with the controls (1.7±0.6 vs 3.5±0.4, p<0.001 and 0.7±0.2 vs 3.5±0.4, p<0.001, respectively). Furthermore, in SRP, MPRI was significantly reduced, compared with PRP (0.7±0.2 vs 1.7±0.6, p<0.001). Subendo-cardial LGE=8.2±1.7 of LV mass was revealed in 1 SLE, 1MCTD and 2 SSc, but in none of PR patients.
Why is this important?
RS is common among young women (primary) and can occur secondary to a wide variety of other conditions including connective tissue disorders. Despite the typically involved areas (fingers, and less commonly the toes), myocardium may also be affected.
MPRI reduction is common in both primary and secondary RS, but it is more severe in secondary, even if RS patients are under treatment with calcium blockers. Occult fibrosis may coexist with the reduced MPRI in SRP but not in PRP
Reference
Tags: lupus, CVD, systemic sclerosis, raynaud's syndrome, CTDs, PM/DM