Coronary artery angiography in systemic lupus erythematosus patients with abnormal myocardial perfusion scintigraphy

Abstract

Objective. According to published studies, 16-82% of systemic lupus erythematosus (SLE) patients have abnormal findings on myocardial perfusion tests, but it has not been established whether these patients also have abnormal findings on coronary angiography. The aim of this study was to evaluate the frequency of abnormal findings on coronary angiography in SLE patients in whom myocardial perfusion scintigraphy revealed abnormalities.Methods. Ninety female SLE patients (ages 20-55 years, disease duration >5 years, and current or previous steroid treatment for >1 year) underwent myocardial perfusion scintigraphy with single-photonemission computed tomography using 99m Tc-sestamibi. Images were taken while the patient was at rest and after dipyridamole-induced stress. Myocardial perfusion defects were identified in 30 patients (33%). Twenty-one of these patients (mean ؎ SD age 42 ؎ 9; mean ؎ SD disease duration 132 ؎ 66 months) agreed to undergo coronary angiography.Results. Atherosclerotic plaques were identified by angiography in 8 of the 21 patients (38%). The majority of coronary abnormalities were localized in the anterior descending artery. The mean ؎ SD number of risk factors for coronary artery disease (CAD) was significantly higher in the subgroup with (4.5 ؎ 0.8) compared with the subgroup without (2.5 ؎ 1.9) abnormal angiographic findings (P ‫؍‬ 0.006). Arterial hypertension and postmenopause status were significantly associated with abnormal angiographic findings. Of the patients with at least 4 risk factors for CAD, coronary stenosis was present in 67% (P ‫؍‬ 0.005). The number of American College of Rheumatology (ACR) criteria for SLE and scores on the SLE Disease Activity Index and the Systemic Lupus International Collaborating Clinics/ACR damage index were also higher in the subgroup with coronary stenosis (P < 0.05).Conclusion. This is the first study to examine coronary angiography results in SLE patients with abnormal findings on myocardial scintigraphy. Our data suggest that myocardial scintigraphy can be used to screen SLE patients and that all patients with abnormal findings plus at least 4 risk factors for CAD should undergo coronary angiography.

Proximal Aortic Stiffness Is Increased in Systemic Lupus Erythematosus Activity in Children and Adolescents

“…Accelerated atherosclerosis is considered an important cause of morbidity and mortality in patients with SLE [16] and highlights the importance of recognizing and controlling modifiable risk factors [17]. …”

Subclinical Atherosclerosis in Systemic Autoimmune Disorders

“…HT is a well recognised risk factor for CV disease development in SLE patients (Petri, PerezGutthann et al 1992) as evidenced by several studies reporting its contribution in plaque formation (IMT measurement, coronary angiography) and arterial stiffening (Sella, Sato et al 2003;Selzer, Sutton-Tyrrell et al 2004;Maksimowicz-McKinnon, Magder et al 2006;Cypiene, Dadoniene et al 2010;Gallelli, Burdick et al 2010). Several studies so far have confirmed the increased prevalence of arterial HT in these patients, ranging from 33% to 56% (de Leeuw, Freire et al 2006;Bellomio, Spindler et al 2009;Duarte, Couto et al 2009;Boucelma, Haddoum et al 2011;Sabio, Vargas-Hitos et al 2011).…”

Beschleunigte Arteriosklerose bei rheumatischen Systemerkrankungen am Beispiel des systemischen Lupus erythematodes—was ist die Konsequenz?

“…Mittels Stress-Myocardszintigraphie wurden Perfusionsdefekte bei 23-40% der untersuchten SLE-Patientinnen ohne Angina pectoris nachgewiesen [4, 16,37]. Bei 8 von 21 Frauen (38%) mit Perfusionsausfällen konnte koronarangiographisch eine KHK bestätigt werden.…”

“…Bei 8 von 21 Frauen (38%) mit Perfusionsausfällen konnte koronarangiographisch eine KHK bestätigt werden. Bei diesen Patientinnen fanden sich signifikant mehr traditionelle Risikofaktoren (insbesondere arterielle Hypertonie), Frauen mit mindestens 4 Risikofaktoren hatten in 67% bereits Koronarstenosen [37].…”