Detection of early impairment of coronary flow reserve in patients with systemic sclerosis

Montisci, Roberta; Vacca, Alessandra; Garau, Pietro; Colonna, Paolo; Ruscazio, Massimo; Passiu, Giuseppe; Iliceto, Sabino; Mathieu, Alessandro

doi:10.1136/ard.62.9.890

Cited by 99 publications

(59 citation statements)

References 14 publications

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“…Alterations of the microvasculature may play a crucial role in the development of SScMI [11][12][13][14][15][16][17]. Observations suggest that coronary flow reserve (CFR) is reduced in SSc despite the lack of atherosclerotic CAD [17][18][19]. Recent studies confirmed this finding among SSc patients; however, mechanisms leading to the restriction of adaptive capacity are still not clear [20,21].…”

Section: Introductionsupporting

confidence: 70%

Diagnosis and mechanisms of cardiac involvement in patients with systemic sclerosis

Pintér

Komócsi

2012

IMAS

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Abstract:Introduction: Systemic sclerosis (SSc) is characterized by fibrosis and vascular abnormalities of skin and internal organs. Cardiac involvement includes coronary artery disease (CAD), pulmonary arterial hypertension (PAH) related right ventricular changes and microvascular disease (MVD). Aims: To characterize the distribution of cardiac alterations and to investigate the mechanisms of the microvascular impairment of SSc patients. Methods: Based on non-invasive investigations, patients were selected for right heart catheterization and intracoronary pressure-wire supplemented coronary angiography. Results: 17 SSc patients (selected from 120 cases) and 17 controls were enrolled. In the "suspected PAH" and the "suspected CAD" groups, PAH was found in 12/20 and 2/10 cases, and coronary artery stenosis in 9/20 and 6/10 cases, respectively. Patients with decreased coronary flow reserve (CFR) had accelerated flow velocity (p<0.05), but myocardial resistance index (IMR) in hyperemia did not differ from patients with normal CFR or from the controls (p=0.292 and p=0.308). The coronary flow velocity of SSc patients correlated to the IMR at baseline (r=0.56, p=0.019). Conclusions: PAH, CAD and MVD show an overlap in symptomatic SSc. The maintained vasodilatation response indicates the paucity of irreversible functional damage of the coronary arterioles. The reduced CFR, the decreased basal IMR and higher velocity pinpoint to possible compensatory vasodilatory mechanisms.

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Section: Introductionsupporting

confidence: 70%

Diagnosis and mechanisms of cardiac involvement in patients with systemic sclerosis

Pintér

Komócsi

2012

IMAS

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“…However, several other studies have been unable to demonstrate a significant difference in arterial stiffness between patients with SSc and controls (41,42). Several studies have found an impaired CFR in patients with rheumatic disease who had no evidence of CVD (43,44); very often, the CFR was reduced but still remained above pathologic values, therefore confirming that the prevalence of microvascular in- volvement is high and more common than large-vessel disease (45).…”

Section: Discussionmentioning

confidence: 82%

“…Furthermore, the majority of our patients were taking immunosuppressive drugs, which have an antiinflammatory effect that potentially affected the atherosclerosis process and, therefore, our results (52,53). The main limitation of this study was the small number of patients; this, in itself, may be due to the low prevalence of SSc (between 3 and 24 cases per 100,000 subjects) (45,46) and the size of our cohort that, however, was similar to the size of other studies.…”

Section: Discussionmentioning

confidence: 89%

Silent cardiovascular involvement in patients with diffuse systemic sclerosis: a controlled cross‐sectional study

Turiel¹,

Gianturco²,

Ricci³

et al. 2013

Arthritis Care & Research

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Objective. An association between systemic autoimmune diseases and atherosclerosis has been described in many connective tissue diseases, and this association is known to lead to increased cardiovascular morbidity and mortality. Systemic sclerosis (SSc) is characterized by multisystem organ inflammation, endothelial wall damage, and vasculopathy. There are many markers of endothelial dysfunction and/or atherosclerotic risk, such as asymmetric dimethylarginine (ADMA), arterial stiffness parameters, carotid intima-media thickness (CIMT), and coronary flow reserve (CFR) assessed by transthoracic echocardiography. The aim of this pilot study was to use various endothelial and atherosclerosis markers to identify early cardiovascular involvement in a group of SSc patients. Methods. The study involved 20 patients (2 men and 18 women with a mean ؎ SD age of 52.96 ؎ 12.51 years) with diffuse SSc who had no signs or symptoms of cardiovascular disease (CVD) and 20 age-and sex-matched controls. All subjects underwent a dipyridamole echocardiographic stress test that included a determination of CFR and an evaluation of CIMT, arterial stiffness, and plasma ADMA levels. Results. All of the arterial wall measurements of the patients with diffuse SSc were significantly different from those of the controls, and both right and left CIMT, pulse wave velocity, and stiffness index (␤) were significantly elevated in the SSc patients compared to the healthy controls. Moreover, in patients with diffuse SSc, CFR was significantly lower (P ‫؍‬ 0.0033) and plasma ADMA levels were higher (P < 0.0001) than in healthy controls. Conclusion. SSc patients without any clinical evidence of CVD seem to have had subclinical atherosclerosis, which was suggested by early impairment of coronary microcirculation and macrovascular involvement.

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“…A group of healthy volunteers served as normal controls. According to literature data, 9 we used 'two proportions power analysis' to establish the study size, which resulted in 20 patients vs. 20 controls.…”

Section: Study Populationmentioning

confidence: 99%

Coronary Microvascular Dysfunction in Asymptomatic Patients Affected by Systemic Sclerosis　– Limited vs. Diffuse Form –

Faccini

Agricola

Oppizzi

et al. 2015

Circ J

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Detection of early impairment of coronary flow reserve in patients with systemic sclerosis

Cited by 99 publications

References 14 publications

Diagnosis and mechanisms of cardiac involvement in patients with systemic sclerosis

Diagnosis and mechanisms of cardiac involvement in patients with systemic sclerosis

Silent cardiovascular involvement in patients with diffuse systemic sclerosis: a controlled cross‐sectional study

Coronary Microvascular Dysfunction in Asymptomatic Patients Affected by Systemic Sclerosis　– Limited vs. Diffuse Form –

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Detection of early impairment of coronary flow reserve in patients with systemic sclerosis

Cited by 99 publications

References 14 publications

Diagnosis and mechanisms of cardiac involvement in patients with systemic sclerosis

Diagnosis and mechanisms of cardiac involvement in patients with systemic sclerosis

Silent cardiovascular involvement in patients with diffuse systemic sclerosis: a controlled cross‐sectional study

Coronary Microvascular Dysfunction in Asymptomatic Patients Affected by Systemic Sclerosis – Limited vs. Diffuse Form –

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Coronary Microvascular Dysfunction in Asymptomatic Patients Affected by Systemic Sclerosis　– Limited vs. Diffuse Form –