Abstract 12323: Prevalence and Severity of Coronary Microvascular Dysfunction in Patients With Systemic Sclerosis and Rheumatoid Arthritis
Background: Connective tissue diseases are associated with coronary microvascular dysfunction (CMD). Since the pathophysiological mechanisms responsible for CMD can vary depending on the underlying disorder, we aimed to noninvasively elucidate the disease-related differences in the prevalence and severity of CMD between systemic sclerosis (SSc) and rheumatoid arthritis (RA).
Methods and Results: Nineteen patients with SSc (the SSc group, 15 women; age 66 ± 9 years), 16 patients with RA (the RA group, 11 women; age 68 ± 8 years), and 19 age- and gender-matched control subjects who have comparable risk factors for coronary artery disease (the Control group, 11 women; age 65 ± 10 years) underwent transthoracic Doppler echocardiography for coronary flow reserve (CFR) measurement in the left anterior descending coronary artery (LAD). Coronary flow velocity was recorded at rest and during hyperemia induced by intravenous infusion of adenosine triphosphate, and a CFR ≤2.5 calculated as the ratio of hyperemic to basal peak and mean diastolic velocity defined CMD. The degree of coronary artery calcification in the LAD was also assessed using the Agatston calcium score (CS) method by 320-row multidetector computed tomography (CTCA). The median disease duration was 7 years in the both patient groups. None of study subjects had fixed coronary artery stenosis more than 25% luminal reduction in the LAD assessed by CTCA and/or invasive coronary angiography, and CS was similar in the 3 groups (the Control group: 173 ± 308, the SSc group: 161 ± 364, and the RA group: 146 ± 250). Although only 16 % in the Control group had CMD, 84 % in the SSc group and 50 % in the RA group had CMD. Overall CFR was significantly lower in the RA group than the Control group, and was further impaired in the SSc group (the Control group: 3.1 ± 0.7, the SSc group: 2.1 ± 0.5*†, and the RA group: 2.6 ± 0.6*, *p≤0.05 vs. the Control group, and †p≤0.05 vs. the RA group).
Conclusions: Connective tissue diseases were associated with CMD. In addition, patients with SSc had much more severe CMD compared with those with RA despite the disease duration and severity of coronary calcification was comparable, suggesting potential disease-related differences between SSc and RA in the pathophysiological mechanisms that lead to CMD.
- © 2013 by American Heart Association, Inc.