Decreased global myocardial perfusion at adenosine stress as a potential new biomarker for microvascular disease in systemic sclerosis: a magnetic resonance study

Abstract

BackgroundPatients with systemic sclerosis (SSc) have high cardiovascular mortality even though there is no or little increase in prevalence of epicardial coronary stenosis. First-pass perfusion on cardiovascular magnetic resonance (CMR) have detected perfusion defects indicative of microvascular disease, but the quantitative extent of hypoperfusion is not known. Therefore, we aimed to determine if patients with SSc have lower global myocardial perfusion (MP) at rest or during adenosine stress, compared to healthy controls, quantified with CMR.MethodsNineteen SSc patients (17 females, 61 ± 10 years) and 22 controls (10 females, 62 ± 11 years) underwent CMR. Twelve patients had limited cutaneous SSc and 7 patients had diffuse cutaneous SSc. One patient had pulmonary arterial hypertension (PAH). MP was quantified using coronary sinus flow (CSF) measurements at rest and during adenosine stress, divided by left ventricular mass (LVM).ResultsThere was no difference in MP at rest between patients and controls (1.1 ± 0.5 vs. 1.1 ± 0.3 ml/min/g, P = 0.85) whereas SSc patients showed statistically significantly lower MP during adenosine stress (3.1 ± 0.9 vs. 4.2 ± 1.3 ml/min/g, P = 0.008). Three out of the 19 SSc patients showed fibrosis in the right ventricle insertion points despite absence of PAH. None had signs of myocardial infarction.ConclusionsPatients with SSc have decreased MP during adenosine stress compared to healthy controls. Thus hypoperfusion at stress may be a sensitive marker of cardiac disease in SSc patients possibly signifying microvascular myocardial disease.

Decreased biventricular longitudinal strain in patients with systemic sclerosis is mainly caused by pulmonary hypertension and not by systemic sclerosis per se

“…CMR data were analysed from 65 patients diagnosed with SSc, whereof 40 without PAH and 25 with PAH. Nineteen healthy controls, from earlier studies in our group (Steding et al ., ; Bodetoft et al ., ; Gyllenhammar et al ., ), were matched with the patient population for gender and age (Mangion et al ., ). Controls had no reported morbidities, including arterial hypertension, diabetes or coronary artery disease, no medical history or medication, and were checked by clinicians before entering the study.…”

CMR feature tracking in cardiac asymptomatic systemic sclerosis: Clinical implications

“…The study was conducted at Skåne University Hospital, Lund, Sweden and Onassis Cardiac Surgery Centre, Athens, Greece and patients were included from both hospitals. Patients fulfilling the American College of Rheumatology criteria [21] and/or LeRoy’s classification criteria for the diagnosis of SSc [22], who were prospectively included in prior studies from our groups [17, 23, 24] and had undergone a CMR exam were retrospectively included and analysed provided they had normal routine cardiac assessment and no cardiac symptoms. Exclusion criteria were known heart disease, renal failure, pulmonary hypertension and contraindications to CMR.…”

Early myocardial damage and microvascular dysfunction in asymptomatic patients with systemic sclerosis: A cardiovascular magnetic resonance study with cold pressor test

“…Myocardial microvascular dysfunction (MD) in SSc has been rarely investigated. A decreased myocardial perfusion was documented in SSc patients with no coronary disease during adenosine stress [ 34 ], as indirectly assessed by measuring coronary sinus flow using velocity-encoded sequence.…”