RESUMEN
Patients with systemic sclerosis (SS) have cardiac dysfunction induced by cold exposure. We and others have demonstrated this finding after corporal chilling, suggesting a "coronary Raynaud phenomenon" mediated by intermittent vascular spasm. In this study we evaluated the effect of diltiazem (DTZ) in cardiac dysfunction induced by cold test in patients with SS without clinical evidence of heart disease. Twelve patients with SS were studied. One patient was excluded because he did not fulfill the prescribed treatment. Eleven patients (age of 49.9 +/- 3.8 years and illness duration of 9.3 +/- 4.8 years) were included. Gated equilibrium radionuclide ventriculography was recorded after red blood cells were labeled in vivo using an intravenous injection of stannous pirophosphate followed by 20 mc of 99 Tc (gamma camera with electrocardiographic R wave gating was used). Left ventricular injection fraction (LVEF) was calculated using computer analysis and wall motion abnormalities by visual interpretation. Patients were cooled using a thermic blanket set at 5 degrees centigrade. They were evaluated before and after a period of cooling. After corporal chilling LVEF decreased more than 10% in all of them. DTZ 270 mg a day was administered to the same patients during 48 hs. Basal and cold LVEF were repeated in all patients. The results with and without DTZ were compared by Student's t Test. The basal LVEF with and without DTZ was not different (64.8 +/- 2.6 and 63.1 +/- 1.8). After corporal chilling LVEF decreased (64.8 +/- 2.6 to 54.8 +/- 2.5 p < 0.00001) and reversible abnormalities in wall motion were noticed in patients without DTZ. When they received DTZ neither difference in LVEF (63.1 +/- 1.8 to 62.1 +/- 2.4) nor wall motion abnormalities were observed. We compared the LVEF after chilling (62.1 +/- 2.4 and 54.8 +/- 2.5) and we found an important difference with the use of DTZ (p < 0.005). It can be concluded that in patients with SS and no overt heart disease, DTZ prevents the early cardiac dysfunction induced by cold test. Probably this drug blunts the coronary spasm induced by cold test in this group of patients.
Asunto(s)
Bloqueadores de los Canales de Calcio/uso terapéutico , Frío/efectos adversos , Diltiazem/uso terapéutico , Esclerodermia Sistémica/complicaciones , Disfunción Ventricular Izquierda/tratamiento farmacológico , Disfunción Ventricular Izquierda/etiología , Temperatura Corporal , Bloqueadores de los Canales de Calcio/farmacología , Diltiazem/farmacología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Función Ventricular Izquierda/efectos de los fármacosRESUMEN
Cardiac abnormalities are frequent in patients with systemic sclerosis (SS). These abnormalities have been demonstrated in over 80% of patients with SS and there are some clues that suggest that an intermittent vascular spasm (i.e. coronary Raynaud's phenomenon) is one of the causes of myocardial dysfunction in this group of patients. The aim of this prospective study was to evaluate the ventricular performance and regional wall motion during exposure to cold in patients with SS and Raynaud's phenomenon without overt cardiac disease. Twenty-four patients and 10 normal volunteers underwent radionuclide ventriculograms (RV). In each subject the RV was done thrice: basal, 20 minutes after chilling with thermic blanket and post reheating. The left ventricular ejection fraction (LVEF) decreased during the cold test (p = 0.03) with reversible abnormalities in wall motion. Basal Right Ventricular Ejection Fraction (RVEF) was lower than that of normal subjects (p = 0.02) and decreased during the cold test (p = 0.04). Therefore, we were able to demonstrate an early cardiac dysfunction associated with impaired wall motion after corporal chilling. These findings suggest that coronary spasm in SS would be an early and frequent phenomenon that would precede the development of symptomatic cardiac disease in some patients with this illness.
Asunto(s)
Vasoespasmo Coronario/complicaciones , Esclerodermia Localizada/fisiopatología , Esclerodermia Sistémica/fisiopatología , Adulto , Femenino , Humanos , Hipotermia Inducida/efectos adversos , Hipotermia Inducida/métodos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Ventriculografía con Radionúclidos , Volumen Sistólico , Función Ventricular/fisiologíaRESUMEN
Cardiac abnormalities are frequent in patients with systemic sclerosis (SS). These abnormalities have been demonstrated in over 80
of patients with SS and there are some clues that suggest that an intermittent vascular spasm (i.e. coronary Raynauds phenomenon) is one of the causes of myocardial dysfunction in this group of patients. The aim of this prospective study was to evaluate the ventricular performance and regional wall motion during exposure to cold in patients with SS and Raynauds phenomenon without overt cardiac disease. Twenty-four patients and 10 normal volunteers underwent radionuclide ventriculograms (RV). In each subject the RV was done thrice: basal, 20 minutes after chilling with thermic blanket and post reheating. The left ventricular ejection fraction (LVEF) decreased during the cold test (p = 0.03) with reversible abnormalities in wall motion. Basal Right Ventricular Ejection Fraction (RVEF) was lower than that of normal subjects (p = 0.02) and decreased during the cold test (p = 0.04). Therefore, we were able to demonstrate an early cardiac dysfunction associated with impaired wall motion after corporal chilling. These findings suggest that coronary spasm in SS would be an early and frequent phenomenon that would precede the development of symptomatic cardiac disease in some patients with this illness.
Asunto(s)
Cardiomegalia/genética , Cardiomiopatía Dilatada/genética , Función Ventricular Izquierda , Adulto , Cardiomegalia/complicaciones , Cardiomegalia/fisiopatología , Cardiomiopatía Dilatada/complicaciones , Cardiomiopatía Dilatada/fisiopatología , Ecocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Linaje , Ventriculografía con RadionúclidosRESUMEN
Se presenta un método simple de marcación in vivo/in vitro de glóbulos rojos con 99mTc. La sangre preestañada del paciente se incuba con el radiotrazador previo agregado de soluciones de hipoclorito de sodio y EDTA sal de sodio, según la técnica descripta por Srivastava y col. El método in vivo/in vitro fue ensayado en 18 pacientes que concurrieron para una evaluación de la fracción de eyección del ventrículo izquierdo. Se hizo un estudio comparativo con otro grupo de 11 pacientes a los cuales se aplicó el método convencional de marcación in vivo. Las imágenes obtenidas con el método in vivo/in vitro, de acuerdo con la evaluación subjetiva de 3 observadores independientes, fueron de mejor calidad y los índices de contraste presentaron menor dispersión de acuerdo al análisis estadístico (p < 0,025)
Asunto(s)
Humanos , Eritrocitos , Técnicas In Vitro , TecnecioRESUMEN
Se presenta un método simple de marcación in vivo/in vitro de glóbulos rojos con 99mTc. La sangre preestañada del paciente se incuba con el radiotrazador previo agregado de soluciones de hipoclorito de sodio y EDTA sal de sodio, según la técnica descripta por Srivastava y col. El método in vivo/in vitro fue ensayado en 18 pacientes que concurrieron para una evaluación de la fracción de eyección del ventrículo izquierdo. Se hizo un estudio comparativo con otro grupo de 11 pacientes a los cuales se aplicó el método convencional de marcación in vivo. Las imágenes obtenidas con el método in vivo/in vitro, de acuerdo con la evaluación subjetiva de 3 observadores independientes, fueron de mejor calidad y los índices de contraste presentaron menor dispersión de acuerdo al análisis estadístico (p < 0,025) (AU)