Abstract
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 (P = 0.03, 2.06 ± 0.61) and to healthy participants (P = 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, P = 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.
Highlights
Cardiovascular (CV) disease including coronary microvascular dysfunction is the leading cause of morbidity and mortality in patients with autoimmune conditions and may be linked with Raynaud phenomenon (RP)
We sought to determine the prevalence of coronary microvascular dysfunction as assessed by Positron emission tomography/computed tomography (PET/CT)-derived coronary flow reserve (MFR) in patients with primary and secondary RP evaluated for dyspnea or chest pain
In patients with secondary RP, only those with underlying systemic sclerosis (SSc) had significantly reduced myocardial flow reserve (MFR) compared to healthy participants (p=0.002, 1.62 ± 0.32 vs 2.22 ± 0.44)
Summary
Cardiovascular (CV) disease including coronary microvascular dysfunction is the leading cause of morbidity and mortality in patients with autoimmune conditions and may be linked with Raynaud phenomenon (RP). Positron emission tomography/computed tomography (PET/CT) has emerged as the noninvasive gold standard for the evaluation of coronary microvascular function. We sought to determine the prevalence of coronary microvascular dysfunction as assessed by PET/CT-derived coronary flow reserve (MFR) in patients with primary and secondary RP evaluated for dyspnea or chest pain
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