Evidence of Myocardial Raynaud’s Phenomenon in Patients with Systemic Sclerosis
Raynauďs phenomenon and myocardial abnormalities are frequently observed in patients with systemic sclerosis (SS). Recent studies, utilizing thallium-201 (T1-201) myocardial imaging during cold pressor stimulus, have shown reversible impairment of myocardial perfusion in these patients. In this study, we examined whether the impairment of myocardial perfusion during cold stress was linked to Raynaud’s phenomenon in six female patients with SS and diffuse scleroderma (mean age, 44 ± 5 years. Serial thallium-201 myocardial single photon emission computed tomography (SPECT) imaging was performed during dipyridamole infusion (DI) (0.56 mg/kg i.v. for 4 min) and during cold stress (CS) (immersion of the hands into water at 15°C for 2 min) over a 2-week period. Left ventricular T1-201 activity, normalized for millicurie-injected dose, was determined in both studies, and the ratio of activity during CS to that during DI served as an index of the CS-induced change in myocardial perfusion. Within 1 week after the T1-201 studies, contact plate thermography during and after CS was performed and the re-warming time (80% recovery) was determined. All patients showed Raynaud’s phenomenon after exposure to cold, although the severity differed among patients: the re-warming time was in the range of 5–40 min. The T1-201 uptake ratio (CS/DI) was inversely correlated with the re-warming time (r = -0.868, P < 0.05), as shown in the Figure.