[Primary scleroderma myocardial disease].

"Primary" myocardial disease is common in patients with systemic sclerosis and appears to be a factor of poor prognosis when clinically evident. An increasing body of evidence suggests that myocardial involvement is due, at least in part, to abnormal vasospasm, with or without associated structural abnormalities, of the small coronary arteries or arterioles. Impaired myocardial perfusion, as well as left and right ventricular dysfunction, have recently been confirmed in this setting, using more sensitive techniques such as tissue Doppler echocardiography and magnetic resonance imaging. Vasodilators such as calcium channel blockers, angiotensin-converting-enzyme inhibitors and an endothelin receptor antagonist improve both myocardial perfusion and functional abnormalities, and their systematic long-term administration might help to prevent these major complications.