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Absence of epicardial coronary stenosis in patients with systemic sclerosis with severe impairment of coronary flow reserve
  1. A Vacca1,
  2. P Siotto2,
  3. A Cauli1,
  4. R Montisci3,
  5. P Garau1,
  6. V Ibba1,
  7. A Mameli1,
  8. G Passiu1,
  9. S Iliceto4,
  10. A Mathieu1
  1. 1IInd Chair of Rheumatology, Department of Medical Sciences, University of Cagliari, Italy
  2. 2Radiology Service, “G Brotzu” Hospital, Cagliari, Italy
  3. 3Department of Cardiology and Neurological Sciences, University of Cagliari, Italy
  4. 4Cardiology Division, University of Padova, Italy
  1. Correspondence to:
    Professor A Mathieu
    Cattedra di Reumatologia II, Dipartimento di Scienze Mediche, University of Cagliari, Policlinico Universitario SS 554, I-09042 Monserrato – Cagliari, Italy; mathieu{at}

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Systemic sclerosis (SSc) is known to be characterised by a diffuse microvascular pathological process leading to cutaneous and visceral changes and to related clinical manifestations.

Both necropsy studies1,2 and in vivo investigations3–5 have shown that in a number of patients with SSc there is evidence of a coronary microvascular disease, while coronary artery disease does not exceed that seen in a control group. In particular, myocardial perfusion defects on thallium-201 scintigraphy usually occur in the absence of angiographic evidence of coronary stenosis.3

Recently, we used a new and non-invasive method of contrast enhanced, transthoracic, second harmonic echo Doppler in patients with SSc to evaluate the coronary flow reserve (CFR), a functional variable measuring the ability of the coronary microvasculature to adapt its lumen to a vasodilating stimulus.6 We detected a significant reduction of the CFR …

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