Myocardial Ischemia in the Absence of Obstructive Coronary Artery Disease in Systemic Lupus Erythematosus

Ishimori, Mariko; Martin, Rebecca; Berman, Daniel S.; Goykhman, Pavel; Shaw, Leslee J.; Shufelt, Chrisandra; Slomka, Piotr J.; Thomson, Louise; Schapira, Jay N.; Yang, Yuching; Wallace, Daniel J.; Weisman, Michael H.; Merz, C. Noel Bairey

doi:10.1016/j.jcmg.2010.09.019

Cited by 152 publications

(110 citation statements)

References 29 publications

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“…Data are accumulating that microvascular dysfunction is an unrecognized source of anginal chest pain in patients with autoimmune diseases such as systemic lupus erythematosus (SLE) 1,2,3 . Studies show that microvascular impairment contributes to cardiovascular disease in other autoimmune conditions such as systemic sclerosis 1,2,4 .…”

Section: To the Editormentioning

confidence: 99%

“…Studies show that microvascular impairment contributes to cardiovascular disease in other autoimmune conditions such as systemic sclerosis 1,2,4 . Patients with SLE presenting with anginal chest pain pose a diagnostic challenge.…”

Section: To the Editormentioning

confidence: 99%

“…We investigated the presence of myocardial ischemia in 18 women with SLE who displayed anginal chest pain in the absence of obstructive CAD on coronary angiography 1 . Eighteen patients and 10 asymptomatic controls underwent adenosine stress CMRI and 64-slice coronary computed tomography (CT) angiography.…”

Section: To the Editormentioning

confidence: 99%

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Microvascular Angina: An Underappreciated Cause of SLE Chest Pain

Ishimori

Anderson²,

Weisman³

et al. 2013

J Rheumatol

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Section: To the Editormentioning

confidence: 99%

Section: To the Editormentioning

confidence: 99%

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Microvascular Angina: An Underappreciated Cause of SLE Chest Pain

Ishimori

Anderson²,

Weisman³

et al. 2013

J Rheumatol

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“…Previous studies from our institution have shown that by using cardiac magnetic resonance (CMR), a prevalence of abnormal stress myocardial perfusion in SLE patients with anginal chest pain in the absence of obstructive coronary artery disease can be observed [7]. SLE patients are particularly at risk of overuse of the emergency department [8].…”

Section: Discussionmentioning

confidence: 99%

Chest pain in lupus patients: the emergency department experience

et al. 2015

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Heart disease, a major cause of morbidity and mortality in SLE patients, often manifests as chest pain (CP). Our goal was to understand the prevalence and outcome of CP presentations for SLE patients in the emergency department (ED). Billing records of patients who presented to Cedars-Sinai Medical Center ED with ICD-9 codes for SLE and secondary ICD-9 codes for CP (786.50-786.59) between March 2009 and October 2013 were reviewed. Two study groups were formed: discharge from ED versus hospital admission. Visits were evaluated for basic cardiac work-up with an electrocardiogram (EKG) and cardiac enzymes; hospital admissions were evaluated for CP etiology and discharge diagnoses. Of 2675 ED visits with ICD-9 codes for SLE, 397 visits had secondary codes for CP (15%); 173 were discharged and 224 became hospital admissions. While 92% of admissions had basic cardiac work-up, over 50% had chest pain attributed to non-cardiac causes. Only 7.2% had a discharge diagnosis related to cardiovascular disease. Fifteen percent of all SLE coded patients had complaints of CP, a figure higher than the national average for non-SLE CP (10%). There is a majority of non-cardiac diagnoses given to SLE patients at discharge. CP is likely to be a window of opportunity to address the known cardiac morbidity and mortality in SLE patients perhaps at an early stage of development of this complication. Our study strengthens the need for more investigations to assess the etiology of CP in this population.

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“…CMR has been used to detect myocardial scars in those patients [79]. Recent work by Ishimori et al even revealed abnormal myocardial CMR stress perfusion despite normal coronary angiography, indicating microvascular impairment [80]. Increased myocardial T2-times were able to differentiate Lupus patients in active inflammation from those in inactive phases or controls [81].…”

Section: Lupusmentioning

confidence: 99%

Cardiovascular magnetic resonance imaging of myocardial inflammation

Waßmuth

Schulz‐Menger

2011

Expert Review of Cardiovascular Therapy

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Cardiovascular magnetic resonance (CMR) imaging can precisely quantify cardiac size and function, but moreover depict tissue changes that are associated with various forms of myocardial inflammation. Thereby, CMR can often detect myocardial inflammation before contractility is obviously impaired. Various CMR techniques to assess aspects of inflammation including T2-weighted imaging, and early- and late-contrast enhanced T1-weighted imaging, are reviewed regarding technical challenges and clinical usefulness. In this article we discuss the available evidence regarding clinical application of CMR in different forms of myocardial inflammation.

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Myocardial Ischemia in the Absence of Obstructive Coronary Artery Disease in Systemic Lupus Erythematosus

Cited by 152 publications

References 29 publications

Microvascular Angina: An Underappreciated Cause of SLE Chest Pain

Microvascular Angina: An Underappreciated Cause of SLE Chest Pain

Chest pain in lupus patients: the emergency department experience

Cardiovascular magnetic resonance imaging of myocardial inflammation

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