Abstract
Objective
According to published studies, 16โ82% 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 20โ55 years, disease duration >5 years, and current or previous steroid treatment for โฅ1 year) underwent myocardial perfusion scintigraphy with singleโphotonโemission computed tomography using ^99m^Tcโsestamibi. Images were taken while the patient was at rest and after dipyridamoleโinduced stress. Myocardial perfusion defects were identified in 30 patients (33%). Twentyโone of these patients (mean ยฑ SD age 42 ยฑ 9; mean ยฑ SD disease duration 132 ยฑ 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 ยฑ SD number of risk factors for coronary artery disease (CAD) was significantly higher in the subgroup with (4.5 ยฑ 0.8) compared with the subgroup without (2.5 ยฑ 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.