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Bosentan Increases Myocardial Perfusion and Function in Systemic Sclerosis: A Magnetic Resonance Imaging and Tissue-Doppler Echography Study
YANNICK ALLANORE, CHRISTOPHE MEUNE, OLIVIER VIGNAUX, SIMON WEBER, PAUL LEGMANN, and ANDRE KAHAN ABSTRACT. Objective. To evaluate the short-term effects of bosentan on myocardial perfusion and function assessed by cardiac magnetic resonance imaging (MRI) and Tissue-Doppler echography (TDE) respectively in patients with systemic sclerosis (SSc). Methods. We prospectively evaluated 18 SSc patients without clinical heart failure and with normal pulmonary arterial pressure. MRI perfusion index and systolic and diastolic strain rates (SR) determined by TDE were assessed at baseline for comparison with healthy controls (after a 72-hour vasodilator washout period), and repeated after 4 weeks of bosentan treatment (62.5 mg bid for 2 weeks titrated to 125 mg bid for 2 weeks). Results. Patients with SSc had decreased MRI perfusion index and TDE SR in comparison with healthy controls. Bosentan treatment led to a significant increase in median (range) global MRI perfusion index [from 0.17 (0.09–0.23) at Day 0 to 0.22 (0.13–0.30) after bosentan treatment; p = 0.0004], systolic SR [from 2.1 (1.3–3.1) s–1 to 2.8 (2.1–4.8) s–1; p = 0.0002), and diastolic SR [from 2.6 (1.4–6.7) to 3.6 (2.0–7.6) s–1; p = 0.0003]. Conclusion. Short-term treatment with bosentan simultaneously improves myocardial perfusion and function, as evaluated by highly sensitive and quantitative methods, in patients with SSc. Whether additional remodeling effect may be observed after longterm treatment with bosentan remains to be determined. (First Release Oct 15 2006; J Rheumatol 2006;33:2464-9) Key Indexing Terms:
SYSTEMIC SCLEROSIS From the Services de Rhumatologie A, Cardiologie, and Radiologie A, Université Paris-Descartes, Faculté de Médecine, Hôpital Cochin, Paris, France. Dr. Kahan has received consulting fees or honoraria from Actelion Pharmaceuticals. Y. Allanore, MD, PhD; A. Kahan, MD, PhD, Service de Rhumatologie A; C. Meune, MD; S. Weber, MD, PhD, Service de Cardiologie; O. Vignaux, MD, PhD; P. Legmann, MD, PhD, Service de Radiologie A, Université Paris-Descartes, Faculté de Médecine, Hôpital Cochin. Dr. Allanore and Dr. Meune contributed equally to the study. Address reprint requests to Dr. Y. Allanore, Hôpital Cochin, Service de Rhumatologie A, 27 rue du faubourg Saint-Jacques, 75014 Paris, France. E-mail: yannick.allanore@cch.aphp.fr Accepted for publication July 31, 2006. |
