Belloli L, Carlo-Stella N, Ciocia G, Chiti A, Massarotti M, Marasini B
Rheumatology Unit, IRCCS Humanitas Clinical Institute, University of Milan, Milan, Italy.
Rheumatology (Oxford). 2008 Jul;47(7):1070-2. doi: 10.1093/rheumatology/ken186. Epub 2008 May 25.
To identify clinical and/or laboratory characteristics that could be risk factors for myocardial microvascular involvement in patients with SSc.
Twenty-one SSc patients, clinically silent for cardiovascular disease, were consecutively evaluated for myocardial perfusion defects through 99m-Tc sestamibi gated myocardial perfusion SPECT with a stress-rest protocol.
Eight patients (38%) had myocardial perfusion defects. Perfusion defects were related to skin scores (P < 0.0001), digital ulcers (P = 0.02) and oesophageal involvement (P = 0.046). A trend for anti-Scl 70 antibody positivity was observed in these patients (P = 0.09). Three SPECT-positive patients had re-establishment of normal myocardial perfusion after a course of prostanoid therapy. There were no significant associations between myocardial involvement and age, sex, diffuse/limited SSc, duration of RP or lung involvement.
Myocardial perfusion defects in SSc patients are frequent, and the presence of severe skin thickness, digital ulcers and perhaps oesophageal involvement might warrant screening for myocardial involvement. Further studies are necessary to evaluate the effect of prostanoid therapy on myocardial perfusion.
确定可作为系统性硬化症（SSc）患者心肌微血管受累危险因素的临床和/或实验室特征。
连续评估21例临床上无心血管疾病症状的SSc患者，通过采用负荷-静息方案的99m锝甲氧基异丁基异腈门控心肌灌注单光子发射计算机断层扫描（SPECT）评估心肌灌注缺损情况。
8例患者（38%）存在心肌灌注缺损。灌注缺损与皮肤评分（P<0.0001）、指端溃疡（P=0.02）和食管受累（P=0.046）相关。在这些患者中观察到抗Scl 70抗体阳性的趋势（P=0.09）。3例SPECT检查阳性的患者在接受前列腺素治疗后心肌灌注恢复正常。心肌受累与年龄、性别、弥漫性/局限性SSc、雷诺现象（RP）持续时间或肺部受累之间无显著相关性。
SSc患者心肌灌注缺损很常见，严重的皮肤增厚、指端溃疡以及可能的食管受累情况可能需要筛查心肌受累情况。有必要进一步研究评估前列腺素治疗对心肌灌注的影响。
