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Prognostic impact of coronary microcirculation abnormalities in systemic sclerosis: a prospective study to evaluate the role of non-invasive tests.

Vacca A, Montisci R, Garau P, Siotto P, Piga M, Cauli A, Ruscazio M, Meloni L, Iliceto S, Mathieu A - Arthritis Res. Ther. (2013)

Bottom Line: Nineteen out of 41 (46%) SSc patients had a reduced CFR (≤2.5) and in 16/41 (39%) a WMA was observed during DSE.An inverse correlation between wall motion score index (WMSI) during DSE and CFR value (r=-0.57, P<0.0001) was observed; in addition, CFR was significantly reduced (2.21±0.38) in patients with WMA as compared to those without (2.94±0.60) (P<0.0001).During a 6.7-±3.5-year follow-up seven patients with abnormal coronary functional tests died of disease-related causes, compared to only one patient with normal tests.

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ABSTRACT

Introduction: Microcirculation dysfunction is a typical feature of systemic sclerosis (SSc) and represents the earliest abnormality of primary myocardial involvement. We assessed coronary microcirculation status by combining two functional tests in SSc patients and estimating its impact on disease outcome.

Methods: Forty-one SSc patients, asymptomatic for coronary artery disease, were tested for coronary flow velocity reserve (CFR) by transthoracic-echo-Doppler with adenosine infusion (A-TTE) and for left ventricular wall motion abnormalities (WMA) by dobutamine stress echocardiography (DSE). Myocardial multi-detector computed tomography (MDCT) enabled the presence of epicardial stenosis, which could interfere with the accuracy of the tests, to be excluded. Patient survival rate was assessed over a 6.7-±3.5-year follow-up.

Results: Nineteen out of 41 (46%) SSc patients had a reduced CFR (≤2.5) and in 16/41 (39%) a WMA was observed during DSE. Furthermore, 13/41 (32%) patients showed pathological CFR and WMA. An inverse correlation between wall motion score index (WMSI) during DSE and CFR value (r=-0.57, P<0.0001) was observed; in addition, CFR was significantly reduced (2.21±0.38) in patients with WMA as compared to those without (2.94±0.60) (P<0.0001). In 12 patients with abnormal DSE, MDCT was used to exclude macrovasculopathy. During a 6.7-±3.5-year follow-up seven patients with abnormal coronary functional tests died of disease-related causes, compared to only one patient with normal tests.

Conclusions: A-TTE and DSE tests are useful tools to detect non-invasively pre-clinical microcirculation abnormalities in SSc patients; moreover, abnormal CFR and WMA might be related to a worse disease outcome suggesting a prognostic value of these tests, similar to other myocardial diseases.

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Inverse correlation between CFR and WMSI in examined SSc patients. Relationship between coronary flow reserve (CFR) and wall motion score index (WMSI) in systemic sclerosis patients. WMSI = difference between rest and peak WMSI (0 to 1 minute after the end of peak dose).
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Figure 2: Inverse correlation between CFR and WMSI in examined SSc patients. Relationship between coronary flow reserve (CFR) and wall motion score index (WMSI) in systemic sclerosis patients. WMSI = difference between rest and peak WMSI (0 to 1 minute after the end of peak dose).

Mentions: An inverse correlation between CFR and WMSI (r = -0.57, P <0.0001) was observed (Figure 2). Moreover, CFR was significantly reduced in patients with induced WMA during DSE (2.21 ± 0.38 vs 2.94 ± 0.60, P = <0.0001); in detail, 13/16 patients (81%) with WMA during DSE also had impaired CFR and only 3 had normal CFR, while among patients without WMA only 6 (24%) showed pathologically reduced CFR and 19 had normal values (P <0.0001).


Prognostic impact of coronary microcirculation abnormalities in systemic sclerosis: a prospective study to evaluate the role of non-invasive tests.

Vacca A, Montisci R, Garau P, Siotto P, Piga M, Cauli A, Ruscazio M, Meloni L, Iliceto S, Mathieu A - Arthritis Res. Ther. (2013)

Inverse correlation between CFR and WMSI in examined SSc patients. Relationship between coronary flow reserve (CFR) and wall motion score index (WMSI) in systemic sclerosis patients. WMSI = difference between rest and peak WMSI (0 to 1 minute after the end of peak dose).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3672666&req=5

Figure 2: Inverse correlation between CFR and WMSI in examined SSc patients. Relationship between coronary flow reserve (CFR) and wall motion score index (WMSI) in systemic sclerosis patients. WMSI = difference between rest and peak WMSI (0 to 1 minute after the end of peak dose).
Mentions: An inverse correlation between CFR and WMSI (r = -0.57, P <0.0001) was observed (Figure 2). Moreover, CFR was significantly reduced in patients with induced WMA during DSE (2.21 ± 0.38 vs 2.94 ± 0.60, P = <0.0001); in detail, 13/16 patients (81%) with WMA during DSE also had impaired CFR and only 3 had normal CFR, while among patients without WMA only 6 (24%) showed pathologically reduced CFR and 19 had normal values (P <0.0001).

Bottom Line: Nineteen out of 41 (46%) SSc patients had a reduced CFR (≤2.5) and in 16/41 (39%) a WMA was observed during DSE.An inverse correlation between wall motion score index (WMSI) during DSE and CFR value (r=-0.57, P<0.0001) was observed; in addition, CFR was significantly reduced (2.21±0.38) in patients with WMA as compared to those without (2.94±0.60) (P<0.0001).During a 6.7-±3.5-year follow-up seven patients with abnormal coronary functional tests died of disease-related causes, compared to only one patient with normal tests.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: Microcirculation dysfunction is a typical feature of systemic sclerosis (SSc) and represents the earliest abnormality of primary myocardial involvement. We assessed coronary microcirculation status by combining two functional tests in SSc patients and estimating its impact on disease outcome.

Methods: Forty-one SSc patients, asymptomatic for coronary artery disease, were tested for coronary flow velocity reserve (CFR) by transthoracic-echo-Doppler with adenosine infusion (A-TTE) and for left ventricular wall motion abnormalities (WMA) by dobutamine stress echocardiography (DSE). Myocardial multi-detector computed tomography (MDCT) enabled the presence of epicardial stenosis, which could interfere with the accuracy of the tests, to be excluded. Patient survival rate was assessed over a 6.7-±3.5-year follow-up.

Results: Nineteen out of 41 (46%) SSc patients had a reduced CFR (≤2.5) and in 16/41 (39%) a WMA was observed during DSE. Furthermore, 13/41 (32%) patients showed pathological CFR and WMA. An inverse correlation between wall motion score index (WMSI) during DSE and CFR value (r=-0.57, P<0.0001) was observed; in addition, CFR was significantly reduced (2.21±0.38) in patients with WMA as compared to those without (2.94±0.60) (P<0.0001). In 12 patients with abnormal DSE, MDCT was used to exclude macrovasculopathy. During a 6.7-±3.5-year follow-up seven patients with abnormal coronary functional tests died of disease-related causes, compared to only one patient with normal tests.

Conclusions: A-TTE and DSE tests are useful tools to detect non-invasively pre-clinical microcirculation abnormalities in SSc patients; moreover, abnormal CFR and WMA might be related to a worse disease outcome suggesting a prognostic value of these tests, similar to other myocardial diseases.

Show MeSH
Related in: MedlinePlus