Myocardial involvement in systemic sclerosis

Objective. To identify clinical and/or laboratory characteristics that could be risk factors for myocardial microvascular involvement in patients with SSc. Methods. Twenty-one SSc patients, clinically silent for cardiovascular disease, were consecutively evaluated for myocardial perfusion defects through 99m-Tc sestamibi gated myocardial perfusion SPECT with a stress-rest protocol. Results. Eight patients (38%) had myocardial perfusion defects. Perfusion defects were related to skin scores (P < 0.0001), digital ulcers (P < 0.02) and oesophageal involvement (P < 0.046). A trend for anti-Scl 70 antibody positivity was observed in these patients (P < 0.09). Three SPECT-positive patients had re-establishment of normal myocardial perfusion after a course of prostanoid therapy. There were no significant associations between myocardial involvement and age, sex, diffuse/limited SSc, duration of RP or lung involvement. Conclusions. Myocardial perfusion defects in SSc patients are frequent, and the presence of severe skin thickness, digital ulcers and perhaps oesophageal involvement might warrant screening for myocardial involvement. Further studies are necessary to evaluate the effect of prostanoid therapy on myocardial perfusion.