A. Feher, MD, PhD, E.K. Oikonomou, MD, PhD, S. Thorn, PhD, Y.H. Liu, PhD, E.J. Miller, MD, PhD, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine.
N.E. Boutagy, PhD, Section of Cardiovascular Medicine, Department of Internal Medicine, and Vascular Biology and Therapeutics Program, and Department of Pharmacology, Yale School of Medicine.
J Rheumatol. 2021 Oct;48(10):1574-1582. doi: 10.3899/jrheum.210040. Epub 2021 Jul 15.
To investigate the association between Raynaud phenomenon (RP) and coronary microvascular dysfunction, we measured myocardial flow reserve (MFR) using positron emission tomography/computed tomography (PET/CT) in patients with primary and secondary RP and controls.
Patients with RP, patient controls, and healthy participants who underwent dynamic rest-stress 82-rubidium PET/CT were studied. Differences in heart rate-blood pressure product-corrected MFR and clinical predictors of reduced MFR (< 2.0) were determined.
Forty-nine patients with RP (80% female; aged 65 ± 11 yrs; 11 with primary RP, 18 with systemic sclerosis [SSc], and 20 with other autoimmune rheumatic diseases [AIRDs] including 6 with systemic lupus erythematosus, 6 with rheumatoid arthritis, 4 with overlap syndrome, 2 with Sjögren syndrome, and 2 with inflammatory arthritis), 49 matched patients without RP or AIRD (78% female; 64 ± 13 yrs), and 14 healthy participants (50% female; 35 ± 5 yrs) were studied. Patients with primary RP, matched patient controls, and healthy participants had comparable MFR. Patients with SSc-RP had significantly reduced MFR (1.62 ± 0.32) compared to matched patient controls ( = 0.03, 2.06 ± 0.61) and to healthy participants ( = 0.01, 2.22 ± 0.44). In multivariable logistic regression, SSc was an independent predictor of reduced MFR. We identified a correlation between time since AIRD diagnosis and MFR (r = -0.30, 95% CI -0.63 to -0.02, = 0.04).
Our findings suggest that only secondary, not primary, RP is associated with reduced MFR, and that patients with SSc-RP have reduced MFR compared to those with primary RP and patients with other AIRDs. Larger prospective studies are warranted to fully elucidate the prognostic value of MFR in patients with secondary RP.
通过正电子发射断层扫描/计算机断层扫描（PET/CT）测量心肌血流储备（MFR），研究原发性和继发性雷诺现象（RP）与冠状动脉微血管功能障碍的关系。
研究了接受动态静息-应激 82-铷 PET/CT 的 RP 患者、患者对照和健康参与者。确定了心率-血压乘积校正 MFR 的差异和 MFR（<2.0）降低的临床预测因素。
49 例 RP 患者（80%为女性；年龄 65±11 岁；11 例原发性 RP，18 例系统性硬化症 [SSc]，20 例其他自身免疫性风湿病 [AIRDs]，包括 6 例系统性红斑狼疮、6 例类风湿关节炎、4 例重叠综合征、2 例干燥综合征和 2 例炎症性关节炎）、49 例无 RP 或 AIRD 的匹配患者（78%为女性；64±13 岁）和 14 例健康参与者（50%为女性；35±5 岁）进行了研究。原发性 RP 患者、匹配患者对照和健康参与者的 MFR 无差异。SSc-RP 患者的 MFR 明显降低（1.62±0.32），与匹配患者对照（<0.01，2.06±0.61）和健康参与者（<0.01，2.22±0.44）相比。在多变量逻辑回归中，SSc 是 MFR 降低的独立预测因素。我们发现 AIRD 诊断后时间与 MFR 之间存在相关性（r=-0.30，95%CI-0.63 至-0.02，P=0.04）。
我们的研究结果表明，只有继发性 RP，而不是原发性 RP，与 MFR 降低相关，且 SSc-RP 患者的 MFR 降低与原发性 RP 患者和其他 AIRD 患者相比。需要更大的前瞻性研究来充分阐明 MFR 在继发性 RP 患者中的预后价值。
