Reduced coronary flow and resistance reserve in primary scleroderma myocardial disease

The maximum coronary vasodilator capacity after intravenous dipyridamole (0.14 mg · kg −1 · min −1 × 4 minutes) was studied in seven patients with primary scieroderma myocardial disease and compared to that of seven control subjects. Hemodynamic data and left ventricular angiographic data were not different in the two groups. The coronary flow reserve was evaluated by the dipyridamole/basal coronary sinus blood flow ratio ( D B CSBF) and the coronary resistance reserve by the dipyridamole/basal coronary resistance ratio ( D B CR). Coronary reserve was greatly impaired in the group with primary scieroderma myocardial disease: D B CSBF was lower than in the control group (2.54 ± 1.37 vs 4.01 ± 0.56, respectively; p < 0.05) and D B CR was higher than in the control group (0.47 ± 0.25 vs 0.23 ± 0.04, respectively; p < 0.05). Such a decreased coronary flow and resistance reserve in patients with primary scleroderma myocardial disease was not explained by an alteration of left ventricular function. It may be an important contributing factor in the pathogenesis of primary scleroderma myocardial disease.