Subendocardial Ischemia and Myocarditis in Systemic Lupus Erythematosus Detected by Cardiac Magnetic Resonance Imaging
| Autor: | Margo Minissian, Mariko L. Ishimori, Pavel Goykhman, Daniel J. Wallace, Chrisandra Shufelt, C. Noel Bairey Merz, Puja K. Mehta, Louise Thomson, Michael H. Weisman, Daniel S. Berman |
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| Rok vydání: | 2012 |
| Předmět: |
medicine.medical_specialty
Ejection fraction Myocarditis medicine.diagnostic_test business.industry Immunology Coronary flow reserve Chest pain medicine.disease Coronary artery disease Rheumatology Cardiac magnetic resonance imaging Internal medicine Cardiology medicine Palpitations Immunology and Allergy Radiology medicine.symptom business Computed tomography angiography |
| Zdroj: | The Journal of Rheumatology. 39:448-450 |
| ISSN: | 1499-2752 0315-162X |
| DOI: | 10.3899/jrheum.110812 |
| Popis: | To the Editor: A 47-year-old woman with systemic lupus erythematosus (SLE) was referred for evaluation of persistent chest pain, characterized as pressure-like substernal pain, associated with shortness of breath and palpitations, worse with exertion, but also occurring at rest, not related to food or body positioning. Medications included hydroxychloroquine, candesartan, and intermittent methylprednisolone for SLE flares, most recently treated 4 months prior to the current office visit. Vital signs, physical examination, and echocardiogram were normal. Computed tomography angiography demonstrated normal coronary arteries without evidence of plaque or calcification. However, an adenosine stress cardiac magnetic resonance imaging (CMRI) perfusion study demonstrated nearly circumferential subendocardial hypoperfusion (Figures 1A, 1B) without evidence of abnormality on T2 or delayed enhancement (DE; Figure 2, A1 and A2) and with a calculated left ventricular ejection fraction (LVEF) of 70%. Selective left coronary angiography, as part of the research protocol, demonstrated no obstructive coronary artery disease (CAD; Figure 3). Coronary reactivity testing showed an abnormal coronary flow reserve of 1.35 (normal > 2.5) in response to intracoronary adenosine, consistent with microvascular coronary dysfunction. Therapy with low-dose aspirin, statin, and carvedilol was initiated, with improvement in chest pain symptoms. Figure 1. First-pass perfusion images through the short axis, 2-chamber views. The images show normal myocardial enhancement at rest (B, D, F) and … Address correspondence to Dr. C.N. Bairey Merz, Cedars-Sinai Medical Center, 444 S. San Vicente Blvd., Suite 600, Los Angeles, CA 90048, USA. E-mail: noel.baireymerz{at}cshs.org. |
| Databáze: | OpenAIRE |
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