ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 0180

Impaired Myocardial Flow Reserve on 82Rubidium Positron Emission Computed Tomography in Patients with Systemic Sclerosis

Attila Feher1, Nabil Boutagy1, Evangelos Oikonomou1, Stephanie Thorn1, Yi-Hwa Liu1, Edward Miller1, Albert Sinusas1 and Monique Hinchcliff2, 1Yale School of Medicine, New Haven, CT, 2Yale School of Medicine, Westport, CT

Meeting: ACR Convergence 2021

Keywords: , , , ,

Session Information

Date: Saturday, November 6, 2021

Title: Imaging of Rheumatic Diseases Poster (0149–0182)

Session Type: Poster Session A

Session Time: 8:30AM-10:30AM

Background/Purpose: 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.

Methods: Patients with RP and matched controls who underwent dynamic rest-stress 82-Rubidium PET/CT from 09/2012-09/2019 for evaluation of chest pain or dyspnea were studied. Differences in heart rate-blood pressure product corrected MFR and clinical predictors of reduced MFR (< 2.0) were determined (Figure 1.).

Results: 49 patients (80% female, 65 ± 11 years) with RP (11 with primary RP, 18 with systemic sclerosis (SSc) and 20 with other autoimmune diagnoses (AID, n=6 systemic lupus erythematosus, n=6 rheumatoid arthritis, n=4 overlap syndrome, n=2 Sjogren’s syndrome, n=2 inflammatory arthritis), 49 patients without RP matched for age, gender and cardiovascular co-morbidities (78% female, 64 ± 13 years) and 14 healthy controls (50% female, 35 ± 5 years) were studied. Primary RP patients, healthy participants and matched control patients had comparable MFR (Figure 2.). In secondary RP patients, only those with underlying SSc had significantly reduced MFR (1.62 ± 0.32) compared to healthy participants (p=0.01, 2.22 ± 0.44) and to matched controls (p=0.03, 2.06 ± 0.61). In univariate (Fig 3A) and multivariable logistic regression (Figure 3B), only SSc was a significant predictor of reduced MFR. We have also identified a correlation between time since autoimmune disease diagnosis and MFR (r= -0.37; 95% CI: -0.61 to -0.09; p=0.01).

Conclusion: Our findings suggest that only secondary, not primary, RP is associated with reduced MFR, and that SSc-RP patients have reduced MFR compared to primary RP and other autoimmune disease patients. Larger prospective studies are warranted to fully elucidate the prognostic value of MFR in patients with secondary RP.

Fig1.jpeg”

Figure 1. Representative relative perfusion images, time activity curves and myocardial blood flow (MBF) values obtained at stress (Str) and rest (Rst) for a patient with systemic sclerosis (A) and for a healthy control subject (B). Perfusion imaging showed no perfusion defects, however for the systemic sclerosis patient blood flow quantification revealed global reduction in stress myocardial blood flow and myocardial flow reserve (<2.0) whereas the healthy control subject had normal myocardial blood flow values. SA: short axis, HLA: horizontal long axis, VLA: vertical long axis, LV: left ventricle, RV: right ventricle, LAD: left anterior descending artery, LCX: left circumflex artery, RCA: right coronary artery.

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Figure 2. Stress myocardial blood flow (MBF) in healthy controls, matched control patients without Raynaud phenomenon (RP) and in patients with primary RP, secondary RP with autoimmune disease (AID) other than systemic sclerosis (SSc) and in patients with SSc.

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Figure 3. Forest plot of odds ratios (OR) of clinical predictors of reduced myocardial flow reserve (MFR <2.0) in univariate (A) and multivariate (B) regression models. BMI: body mass index, RP: Raynaud phenomenon, CT: computed tomography, PET: positron emission tomography, CI: confidence interval.

Disclosures: A. Feher, None; N. Boutagy, None; E. Oikonomou, None; S. Thorn, None; Y. Liu, None; E. Miller, None; A. Sinusas, None; M. Hinchcliff, None.

To cite this abstract in AMA style:

Feher A, Boutagy N, Oikonomou E, Thorn S, Liu Y, Miller E, Sinusas A, Hinchcliff M. Impaired Myocardial Flow Reserve on 82Rubidium Positron Emission Computed Tomography in Patients with Systemic Sclerosis [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/impaired-myocardial-flow-reserve-on-82rubidium-positron-emission-computed-tomography-in-patients-with-systemic-sclerosis/. Accessed .

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