COLD-INDUCED CORONARY RAYNAUDS-PHENOMENON IN PATIENTS WITH SYSTEMIC-SCLEROSIS

Objective: Cardiac involvement with myocardial-band necrosis is common in systemic sclerosis. One possible explanation is that an underlying vasomotor-abnormality accounts for these histologic findings. To shed light on this issue we investigated the existence of ''myocardial Ray naud's phenomenon'' in such patients. Methods: We examined 25 patients with systemic sclerosis and 14 patients with systemic lupus erythemat osus or rheumatoid arthritis, using cold pressor and dipyridamole-thal lium-201 scintigraphy. Results: Twenty-three patients with systemic sc lerosis and 13 patients with lupus erythematosus or rheumatoid arthrit is had normal perfusion during dipyridamole imaging. Seven scleroderma ma patients with normal dipyridamole test presented cold-induced tran sient myocardial ischemia, while none of the control patients had cold -induced ischemia (p = 0.034). All patients with cold-induced ischemic defects presented long-standing Raynaud's phenomenon (> 5 years); of the 14 patients with long-standing Raynaud's phenomenon 7 presented is chemic thallium-201 defects; of the remaining 9 patients with Raynaud' s phenomenon of short duration (< 5 years) none presented cold-induced ischemia (p = 0.019). Conclusion: Patients with systemic sclerosis an d long-standing Raynaud's phenomenon, even in the presence of normal m yocardial perfusion during pharmacological vasodilation with dipyridam ole, may present cold-induced myocardial ischemia, a functional Raynau d's phenomenon of the heart.