title: Myocardial perfusion in peripheral Raynaud's phenomenon. Evaluation using stress cardiovascular magnetic resonance.
abstract: BACKGROUND
  Peripheral Raynaud's phenomenon (RP) is either primary (PRP), without any coexisting disease or secondary (SRP), due to connective tissue diseases (CTD). We hypothesized that adenosine stress cardiovascular magnetic resonance (CMR) can assess myocardial perfusion in a population of PRP and SRP.
  
  
  METHODS
  Twenty CTDs, aged 30.6±7.5yrs., 16F/4M, including 9 systemic sclerosis (SSc), 4 systemic lupus erythematosus (SLE), 3 mixed connective tissue disease (MCTD), 2 polymyositis (PM) and 2 rheumatoid arthritis (RA), with SRP, under treatment with calcium blockers, were evaluated by stress CMR and compared with age-sex matched PRP and controls. All RP patients were under treatment with calcium blockers. Stress perfusion CMR was performed by 1.5T system using 140mg/kg/min adenosine for 4min and 0.05mmol/kg Gd-DTPA for first-pass perfusion. A rest perfusion was performed with the same protocol. Late gadolinium enhanced (LGE) images were acquired after another dose of Gd-DTPA.
  
  
  RESULTS
  In both PRP, SRP, the myocardial perfusion reserve index (MPRI) was significantly reduced compared with the controls (1.7±0.6 vs 3.5±0.4, p<0.001 and 0.7±0.2 vs 3.5±0.4, p<0.001, respectively). Furthermore, in SRP, MPRI was significantly reduced, compared with PRP (0.7±0.2 vs 1.7±0.6, p<0.001). Subendo-cardial LGE=8.2±1.7 of LV mass was revealed in 1 SLE, 1MCTD and 2 SSc, but in none of PR patients.
  
  
  CONCLUSIONS
  MPRI reduction is common in both PRP and SRP, but it is more severe in SRP, even if RP patients are under treatment with calcium blockers. Occult fibrosis may coexist with the reduced MPRI in SRP but not in PRP.
authors.affiliation: Onassis Cardiac Surgery Center, Athens, Greece. Electronic address: soma13@otenet.gr.
authors.forename: Sophie
authors.initials: S
authors.lastname: Mavrogeni
authors.affiliation: Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Bratis
authors.affiliation: Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece.
authors.forename: Loukia
authors.initials: L
authors.lastname: Koutsogeorgopoulou
authors.affiliation: Athens Navy Hospital, Athens, Greece.
authors.forename: Georgia
authors.initials: G
authors.lastname: Karabela
authors.affiliation: Athens Navy Hospital, Athens, Greece.
authors.forename: Efthymios
authors.initials: E
authors.lastname: Savropoulos
authors.affiliation: Athens Navy Hospital, Athens, Greece.
authors.forename: Gikas
authors.initials: G
authors.lastname: Katsifis
authors.affiliation: Asklipion Hospital, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Raftakis
authors.affiliation: Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Markousis-Mavrogenis
authors.affiliation: Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: Genovefa
authors.initials: G
authors.lastname: Kolovou
mesh_terms: D000328:Adult; D003326:Coronary Circulation / Q000502:physiology*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D011928:Raynaud Disease / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D015203:Reproducibility of Results
keywords: Myocardial fibrosis; Myocardial ischemia; Raynaud's phenomenon; Stress cardiovascular magnetic resonance