title: Cold-induced coronary Raynaud's phenomenon in patients with systemic sclerosis.
abstract: OBJECTIVE
  Cardiac involvement with myocardial-band necrosis is common in systemic sclerosis. One possible explanation is that an underlying vasomotor abnormality accounts for these histologic findings. To shed light on this issue we investigated the existence of "myocardial Raynaud's phenomenon" in such patients.
  
  
  METHODS
  We examined 25 patients with systemic sclerosis and 14 patients with systemic lupus erythematosus or rheumatoid arthritis, using cold pressor and dipyridamole-thallium-201 scintigraphy.
  
  
  RESULTS
  Twenty-three patients with systemic sclerosis and 13 patients with lupus erythematosus or rheumatoid arthritis had normal perfusion during dipyridamole imaging. Seven scleroderma patients with normal dipyridamole test presented cold-induced transient myocardial ischemia, while none of the control patients had cold-induced ischemia (p = 0.034). All patients with cold-induced ischemic defects presented long-standing Raynaud's phenomenon (> 5 years); of the 14 patients with long-standing Raynaud's phenomenon 7 presented ischemic thallium-201 defects; of the remaining 9 patients with Raynaud's phenomenon of short duration (< 5 years) none presented cold-induced ischemia (p = 0.019).
  
  
  CONCLUSIONS
  Patients with systemic sclerosis and long-standing Raynaud's phenomenon, even in the presence of normal myocardial perfusion during pharmacological vasodilation with dipyridamole, may present cold-induced myocardial ischemia, a functional Raynaud's phenomenon of the heart.
authors.affiliation: Department of Clinical Therapeutics, Alexandra University Hospital, Athens, Greece.
authors.forename: J
authors.initials: J
authors.lastname: Lekakis
authors.forename: M
authors.initials: M
authors.lastname: Mavrikakis
authors.forename: M
authors.initials: M
authors.lastname: Emmanuel
authors.forename: V
authors.initials: V
authors.lastname: Prassopoulos
authors.forename: S
authors.initials: S
authors.lastname: Papazoglou
authors.forename: C
authors.initials: C
authors.lastname: Papamichael
authors.forename: D
authors.initials: D
authors.lastname: Moulopoulou
authors.forename: P
authors.initials: P
authors.lastname: Kostamis
authors.forename: S
authors.initials: S
authors.lastname: Stamatelopoulos
authors.forename: S
authors.initials: S
authors.lastname: Moulopoulos
mesh_terms: D000328:Adult; D000368:Aged; D003080:Cold Temperature; D003326:Coronary Circulation / Q000502:physiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004176:Dipyridamole; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011928:Raynaud Disease / Q000503:physiopathology*; D012595:Scleroderma, Systemic / Q000503:physiopathology*; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D013794:Thallium Radioisotopes; D004176:Dipyridamole