Blunted coronary flow reserve in systemic sclerosis

Sulli, Alberto; Ghio, Massimo; Bezante, Gianpaolo; Deferrari, Luca; Craviotto, C; Sebastiani, Valeria; Setti, Maurizio; Barsotti, Antonio; Cutolo, Maurizio; Indiveri, Francesco

doi:10.1093/rheumatology/keh087

Cited by 50 publications

(28 citation statements)

References 24 publications

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“…As for regional systolic function, in our SSc population, despite normal LV ejection fraction and DMI systolic peak velocities, a significant reduction of Strain and SR indexes at the level of both IVS and LV lateral free wall was detected, pointing out an early direct involvement of LV ventricular walls by the myopathic process, at a time when other global and regional systolic parameters remain normal. As for coronary and peripheral vascular function in SSc, the CFR impairment in our patients is likely to detect an anatomical and/or functional impairment in coronary microvasculature, because the presence of an involvement of small coronary arteries has been showed by others even in absence of abnormalities of epicardial coronary arteries [5,6]. However, further evidence is provided by our data that endothelial dysfunction in SSc patients is not confined to the coronary microcirculation, but also extends to large peripheral conduit arteries.…”

supporting

confidence: 61%

“…Such involvement is historically classified into primary and secondary. Primary heart disease depends on the involvement of myocardium and microvascolature by SSc disease itself, with impairment of global diastolic function and reduction of coronary flow reserve, even in asymptomatic patients without abnormalities of epicardial coronary arteries [4][5][6]. Secondary form of cardiac disease develops in SSc patients with vascular and/or interstitial lung disease, in which the fibrotic process leads to major reduction in the cross-sectional area of pulmonary vascular bed due to obliteration of alveolar capillaries and/or narrowing of many small arteries [7,8].…”

mentioning

confidence: 99%

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Myocardial and vascular dysfunction in systemic sclerosis: The potential role of noninvasive assessment in asymptomatic patients

D’Andrea

Caso

Cuomo

et al. 2007

International Journal of Cardiology

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supporting

confidence: 61%

mentioning

confidence: 99%

Myocardial and vascular dysfunction in systemic sclerosis: The potential role of noninvasive assessment in asymptomatic patients

D’Andrea

Caso

Cuomo

et al. 2007

International Journal of Cardiology

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“…Noninvasive methods were used to asses subclinical atherosclerosis in SSc, including IMT and IBPI, with contradicting results [65,66]. Studying other variables such as traditional risk factors, disease duration, patients' age, the presence of anticentromer or antitopoisomerase antibodies, ANA, and the type of SSc (limited and diffuse and abnormalities in lung function tests), shows that only patients' age is associated to increase risk of atherosclerosis, an association opposed by some studies [67,68].…”

Section: Accelerated Atherosclerosis In Sscmentioning

confidence: 99%

Atherosclerosis in Autoimmune Rheumatic Diseases—Mechanisms and Clinical Findings

Zinger

Sherer

Shoenfeld

2008

Clinic Rev Allerg Immunol

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Atherosclerosis is one of the major entities leading to morbidity and mortality in the western world. It is known now that atherosclerosis cannot be explained merely by the presence of the Framingham traditional risk factors and that autoimmunity takes a significant role in its pathogenesis. It is also known that individuals with autoimmune diseases demonstrate increased incidence of cardiovascular manifestations and subclinical atherosclerotic disease. The mechanisms for the assumed accelerated atherosclerosis in diseases such as systemic lupus erythematosus, rheumatoid arthritis, antiphospholipid syndrome, and systemic sclerosis include the classical risk factors, but may also be due to chronic inflammatory processes and immune dysregulation. Autoantibodies, autoantigens, pro-inflammatory cytokines, and infectious agents play a role in that process. Involvement of autoimmunity in the pathogenesis of accelerated atherosclerosis in rheumatic diseases and the common pathway that leads to this condition may lead to significant change in prevention of treatment.

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“…Unlike microvascular disease, this has not been studied extensively. Impaired coronary artery reserve has previously been demonstrated in SSc patients by noninvasive imaging techniques (5)(6)(7). Studies published a few decades ago suggested an underlying microvascular disease of the myocardium, based on normal findings on coronary angiogram (8) and the absence of coronary atherosclerosis upon histologic examination at autopsy (9)(10)(11)(12).…”

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confidence: 99%

Systemic sclerosis is an independent risk factor for increased coronary artery calcium deposition

Mok¹,

Lau²,

Chiu³

et al. 2011

Arthritis & Rheumatism

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Objective. Endothelial dysfunction and inflammation are pathogenic mechanisms common to systemic sclerosis (SSc) and atherosclerosis. This study was undertaken to examine the relationship between coronary atherosclerosis, as assessed by the coronary artery calcium score (CACS), and conventional cardiovascular and disease-specific risk factors in SSc patients.Methods. The CACS was measured by computed tomography, and cardiovascular risk factors were examined in SSc patients and compared with controls matched for age, sex, and glycemic status. Disease activity score, antiphospholipid antibodies, highsensitivity C-reactive protein level, and erythrocyte sedimentation rate were measured in SSc patients. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were determined.Results. We recruited 53 SSc patients (50 women and 3 men) and 106 controls. The patients had a mean ؎ SD age of 53.1 ؎ 12.9 years and a median disease duration of 9 years. Compared to controls, SSc patients had significantly lower low-density lipoprotein (LDL) cholesterol levels (P ‫؍‬ 0.001), high-density lipoprotein cholesterol levels (P ‫؍‬ 0.01), diastolic blood pressure, waist circumference, and body mass index and were more likely to be receiving vasodilators (all P < 0.001). There was a significantly higher proportion of SSc patients among subjects with more severe coronary calcification (CACS >101) compared to those with lesser severity (CACS <100) (56.5% versus 29.4%; P ‫؍‬ 0.01). Multiple logistic regression analysis revealed SSc to be an independent determinant for a CACS >101 (OR 10.89 [95% CI 2.21-53.75], P ‫؍‬ 0.003) together with age and LDL cholesterol level after adjustment for other cardiovascular risk factors. Among diseasespecific factors, only disease duration (OR 1.14 [95% CI 1.02-1.27], P ‫؍‬ 0.02) was independently associated with more severe coronary calcification (CACS >101).Conclusion. Our findings indicate that SSc is an independent risk factor for coronary calcification, in addition to the conventional risk factors for coronary atherosclerosis, such as age and hypertension.

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Blunted coronary flow reserve in systemic sclerosis

Abstract: CFR is often reduced in SSc patients. CFR was lower in patients with dSSc than in those affected by lSSc. A reduced CFR value should be considered an indirect sign of heart involvement in scleroderma, but its clinical and prognostic implications need to be clarified.

Cited by 50 publications

References 24 publications

Myocardial and vascular dysfunction in systemic sclerosis: The potential role of noninvasive assessment in asymptomatic patients

Myocardial and vascular dysfunction in systemic sclerosis: The potential role of noninvasive assessment in asymptomatic patients

Atherosclerosis in Autoimmune Rheumatic Diseases—Mechanisms and Clinical Findings

Systemic sclerosis is an independent risk factor for increased coronary artery calcium deposition

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