Cold-induced coronary Raynaud's phenomenon in patients with systemic sclerosis

Area of Science:

• Cardiology
• Rheumatology
• Vascular Medicine

Background:

• Cardiac involvement, including myocardial necrosis, is frequent in systemic sclerosis.
• Vasomotor abnormalities are a potential cause of these cardiac findings.
• Investigating a cardiac manifestation of Raynaud's phenomenon is crucial.

Purpose of the Study:

• To explore the existence of "myocardial Raynaud's phenomenon" in patients with systemic sclerosis.
• To determine if cold exposure triggers myocardial ischemia in these patients.
• To differentiate cardiac vasomotor dysfunction from other causes of cardiac involvement.

Main Methods:

• Studied 25 patients with systemic sclerosis and 14 control patients (lupus or rheumatoid arthritis).
• Utilized cold pressor testing and dipyridamole-thallium-201 scintigraphy to assess myocardial perfusion.
• Correlated findings with the duration of Raynaud's phenomenon.

Main Results:

• Seven out of 25 systemic sclerosis patients with normal dipyridamole tests showed cold-induced transient myocardial ischemia.
• None of the control patients exhibited cold-induced ischemia (p = 0.034).
• Cold-induced ischemia was significantly associated with long-standing Raynaud's phenomenon (> 5 years) (p = 0.019).

Conclusions:

• Systemic sclerosis patients with long-standing Raynaud's phenomenon can develop cold-induced myocardial ischemia.
• This phenomenon occurs despite normal myocardial perfusion during dipyridamole vasodilation.
• This suggests a functional "Raynaud's phenomenon of the heart" in systemic sclerosis.