Evaluation of the effect of nifedipine upon myocardial perfusion and contractility using cardiac magnetic resonance imaging and tissue Doppler echocardiography in systemic sclerosis
Evaluation of the effect of nifedipine upon myocardial perfusion and contractility using cardiac magnetic resonance imaging and tissue Doppler echocardiography in systemic sclerosis
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DOI：
10.1136/ard.2004.031484
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发表时间：
2005-09-01
影响因子：
27.4
通讯作者：
Kahan, A
中科院分区：
文献类型：
--
作者：
Vignaux, O;Allanore, Y;Kahan, A
背景：在系统性硬化症(SSC)中，由于微循环障碍而导致的原发心肌损害是常见的。近年来，心血管磁共振成像(MRI)和组织多普勒超声心动图(TDE)被证明分别比传统方法更敏感地评估心肌的血流灌注和收缩能力。目的：研究硝苯地平对SSc患者心肌血流灌注和心肌收缩功能的影响。患者和方法：前瞻性评估18例SSc患者(女性14例，男性4例；平均(SD)年龄59(9)岁；平均(SD)病程7(4年)年；10例弥漫性(弥漫性)和8例局限性皮肤形态)。结果：服用硝苯地平后，患者的磁共振血流灌注指数显著增加(基线时平均(SD)0.26(0.07)vs 0.19(0.05)，p=0.0003)，收缩和舒张期应变率(2.3vs1.5(0.4)S(-1))显著增加(p=0.0002)。和4.2v3.0(P=0.0003)。结论：硝苯地平治疗14天可同时改善心肌血流灌注和功能，可用高灵敏度和定量方法进行评估。
Background: Primary myocardial involvement due to microcirculation impairment is common in systemic sclerosis (SSc). Cardiovascular magnetic resonance imaging (MRI) and tissue Doppler echocardiography (TDE) were recently shown to be more sensitive than conventional methods for the respective assessment of myocardial perfusion and contractility. Previous studies have suggested that dihydropyridine-type calcium channel blockers mitigate both myocardial perfusion and function abnormalities.Objective: To investigate the effects of nifedipine on myocardial perfusion by MRI and on contractility by TDE, in patients with SSc.Patients and methods: 18 patients with SSc without clinical heart failure and with normal pulmonary arterial pressure ( 14 women, 4 men; mean (SD) age 59 ( 9) years; mean ( SD) disease duration 7 ( 4) years, 10 with diffuse and 8 with limited cutaneous forms) were prospectively evaluated. The MRI perfusion index, determined from time-intensity curves, and systolic and diastolic strain rate determined by TDE were assessed at baseline, after a 72 hour vasodilator washout period, and after 14 days of oral treatment with nifedipine 60 mg/day.Results: Nifedipine treatment led to a significant increase in the MRI perfusion index ( mean ( SD) 0.26 (0.07) v 0.19 (0.05) at baseline, p = 0.0003) and in systolic and diastolic strain rate (2.3 (0.6) v 1.5 (0.4) s(-1) at baseline, p = 0.0002, and 4.2 (1.6) v 3.0 (1.2) at baseline, p = 0.0003, respectively).Conclusion: Fourteen days of treatment with nifedipine simultaneously improves myocardial perfusion and function, as evaluated by highly sensitive and quantitative methods.