EFFECT OF DILTIAZEM ON COLD-INDUCED LEFT- VENTRICULAR DYSFUNCTION IN PATIENTS WITH SYSTEMIC-SCLEROSIS

Patients with systemic sclerosis (SS) have cardiac dysfunction induced by cold exposure. We and others have demonstrated this finding after corporal chilling, suggesting a <<coronary Raynaud phenomenon>> mediat ed by intermittent vascular spasm. In this study we evaluated the effe ct of diltiazem (DTZ) in cardiac dysfunction induced by cold test in p atients with SS without clinical evidence of heart disease. Twelve pat ients with SS were studied. One patient was excluded because he did no t fulfill the prescribed treatment. Eleven patients (age of 49.9 +/- 3 .8 years and illness duration of 9.3 +/- 4.8 years) were included. Gat ed equilibrium radionuclide ventriculography was recorded after red bl ood cells were labelled in vivo using an intravenous injection of stan nous pirophosphate followed by 20 mc of 99 Tc (gamma camera with elect rocardiographic R wave gating was used). Left ventricular injection fr action (LVEF) was calculated using computer analysis and wall motion a bnormalities by visual interpretation. Patients were cooled using a th ermic blanket set at 5 degrees centrigrades. They were evaluated befor e and after a period of cooling. After corporal chilling LVEF decrease d more than 10% in all of them. DTZ 270 mg a day was administered to t he same patients during 48 hs. Basal and cold LVEF were repeated in al l patients. The results with and without DTZ were compared by Student' s t Test. The basal LVEF with and without DTZ was not different (64.8 +/- 2.6 and 63.1 +/- 1.8). After corporal chilling LVEF decreased (64. 8 +/- 2.6 to 54.8 +/- 2.5 p < 0.00001) and reversible abnormalities in wall motion were noticed in patients without DTZ. When they received DTZ neither difference in LVEF (63.1 +/- 1.8 to 62.1 +/- 2.4) nor wall motion abnormalities were observed. We compared the LVEF after chilli ng (62.1 +/- 2.4 and 54.8 +/- 2.5) and we found an important differenc e with the use of DTZ (p < 0.005).