| Autor: |
Sandhu, Vaneet K., Wei, Janet, Thomson, Louise E. J., Berman, Daniel S., Schapira, Jay, Wallace, Daniel, Weisman, Michael H., Merz, C. Noel Bairey, Ishimori, Mariko L. |
| Jazyk: |
angličtina |
| Rok vydání: |
2020 |
| Předmět: |
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| Zdroj: |
Arthritis Care Res (Hoboken) |
| Popis: |
OBJECTIVE: We investigated prospective change in the prevalence of coronary microvascular dysfunction (CMD) and obstructive coronary artery disease (CAD) in a cohort of systemic lupus erythematosus (SLE) subjects initially evaluated for anginal chest pain (CP). BACKGROUND: Prior work documented a relatively high prevalence of CMD in the absence of obstructive CAD in subjects with SLE. METHODS: Twenty female SLE subjects with CP who underwent stress cardiac magnetic resonance imaging (CMRI) and coronary computed tomography angiography (CCTA) at baseline were re-evaluated at 5 years. RESULTS: Seventeen subjects (85%) were available and re-enrolled, of which eleven (65%) had persistent chest pain on follow up. Fourteen subjects had complete follow up CMRI, of which 36% (5/14) demonstrated CMD on follow up. Further, 25% (¼) of the originally abnormal MPRI at baseline were lower at follow up, while 2 additionally abnormal MPRI values on follow up were noted in previously normal MPRIs. Both prevalence of CMD and non-obstructive/obstructive CAD were unchanged between baseline and follow up, respectively (both p=ns). During follow up, 33% (5/15) had adverse cardiac outcomes including pericarditis, unstable angina or intracranial aneurysm clipping procedure. CONCLUSIONS: At 5-year follow up of SLE subjects with CP evaluated at baseline and follow up, a majority had persistent CP and nearly half had similar or worse myocardial perfusion consistent with CMD without obstructive CAD. These findings propose an alternative explanation for CP in SLE subjects compared to the more common SLE-related accelerated obstructive CAD accounting for CP and adverse outcomes. These findings support further studies of CMD as an etiology for cardiac morbidity and mortality in SLE. SIGNIFICANCE: Cardiovascular disease (CVD) is the major contributor to morbidity and mortality in SLE. Our research suggests that coronary microvascular dysfunction (CMD) measured by cardiac magnetic resonance imaging (CMRI) plays a role in SLE. INNOVATION: Our results support that obstructive CAD is not related to persistent chest pain, while persistent/worsened evidence of CMD is associated with persistent chest pain. Advanced imaging allows for a non-invasive evaluation of CVD including CMD, which appears to be prevalent in SLE. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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