Myocardial perfusion in peripheral Raynaud's phenomenon. Evaluation using stress cardiovascular magnetic resonance

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• 作者：Sophie Mavrogeni^a ; ^{soma13@otenet.gr} ; Konstantinos Bratis^a ; Loukia Koutsogeorgopoulou^b ; Georgia Karabela^c ; Efthymios Savropoulos^c ; Gikas Katsifis^c ; John Raftakis^d ; George Markousis-Mavrogenis^a ; Genovefa Kolovou^a
• 关键词：Raynaud's phenomenon ; Stress cardiovascular magnetic resonance ; Myocardial ischemia ; Myocardial fibrosis
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 February 2017
• 年：2017
• 卷：228
• 期：Complete
• 页码：444-448
• 全文大小：541 K
• 卷排序：228

文摘

Peripheral Raynaud's phenomenon (RP) is either primary (PRP), without any coexisting disease or secondary (SRP), due to connective tissue diseases (CTD). We hypothesized that adenosine stress cardiovascular magnetic resonance (CMR) can assess myocardial perfusion in a population of PRP and SRP.Patients-methodsTwenty CTDs, aged 30.6 ± 7.5 yrs., 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 SRP, under treatment with calcium blockers, were evaluated by stress CMR and compared with age-sex matched PRP and controls. All RP patients were under treatment with calcium blockers. Stress perfusion CMR was performed by 1.5 T system using 140 mg/kg/min adenosine for 4 min and 0.05 mmol/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.ResultsIn both PRP, SRP, 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.ConclusionsMPRI reduction is common in both PRP and SRP, but it is more severe in SRP, even if RP patients are under treatment with calcium blockers. Occult fibrosis may coexist with the reduced MPRI in SRP but not in PRP.