Coronary artery angiography in systemic lupus erythematosus patients with abnormal myocardial perfusion scintigraphy
Article first published online: 4 NOV 2003
Copyright © 2003 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 48, Issue 11, pages 3168–3175, November 2003
How to Cite
Sella, E. M. C., Sato, E. I. and Barbieri, A. (2003), Coronary artery angiography in systemic lupus erythematosus patients with abnormal myocardial perfusion scintigraphy. Arthritis & Rheumatism, 48: 3168–3175. doi: 10.1002/art.11260
- Issue published online: 4 NOV 2003
- Article first published online: 4 NOV 2003
- Manuscript Accepted: 13 JUN 2003
- Manuscript Received: 19 SEP 2002
- Fundação de Amparo à Pesquisa do Estado de São Paulo. Grant Number: 98/11794-6
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.
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-photon–emission computed tomography using 99mTc-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.
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).
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.