EXTENDED REPORT

Myocardial perfusion scintigraphy and coronary disease risk factors in systemic lupus erythematosus

E M C Sella¹, E I Sato¹, W A Leite², J A Oliveira Filho², A Barbieri³

¹ Rheumatology Division, Universidade Federal de São Paulo, Escola Paulista de Medicina, Brazil
² Cardiology Division, Universidade Federal de São Paulo, Escola Paulista de Medicina, Brazil
³ Image Department, Universidade Federal de São Paulo, Escola Paulista de Medicina, Brazil

Correspondence to:
Correspondence to:
Professor E I Sato, Universidade Federal de São Paulo, Escola Paulista de Medicina, Reumatologia, Rua Botucatu 740-Vila Clementino, CEP 04023 900, São Paulo, Brazil;
emiliasato{at}reumato.epm.br

Objective: To evaluate the prevalence of myocardial perfusion abnormalities and the possible association between myocardial perfusion defects and traditional coronary artery disease (CAD) risk factors as well as systemic lupus erythematosus (SLE) related risk factors.

Patients and methods: Female patients with SLE, disease duration >5 years, age 18–55 years, who had used steroids for at least one year were enrolled. Traditional CAD risk factors evaluated were arterial hypertension, diabetes mellitus, dyslipidaemia, postmenopausal status, smoking, obesity, and premature family CAD profile. Myocardial perfusion scintigraphy was evaluated by single photon emission computed tomography with technetium 99m-sestamibi at rest and after dipyridamole induced stress.

Results: Eight two female patients with SLE without angina pectoris with mean (SD) age 37 (10) years, disease duration 127 (57) months, SLE Disease Activity Index (SLEDAI) score 6 (5), and SLICC/ACR-DI score 2 (2) were evaluated. Myocardial perfusion abnormalities were found in 23 patients (28%). The mean (SD) number of CAD risk factors was 2.2 (1.6). There was a significant positive correlation between age and number of CAD risk factors. Lower high density lipoprotein (HDL) cholesterol level showed a significant association with abnormal scintigraphy. Logistic regression analysis showed that lower HDL cholesterol level and diabetes mellitus were associated with myocardial perfusion abnormalities. Current vasculitis was also associated with abnormal scintigraphy.

Conclusions: Lower HDL cholesterol level and diabetes mellitus have a significant influence on abnormal myocardial perfusion results found in asymptomatic patients with SLE. Current vasculitis was associated with abnormal myocardial scintigraphy. These data suggest that abnormal myocardial scintigraphy may be related to subclinical atherosclerosis.

Keywords: systemic lupus erythematosus; angina pectoris; coronary artery disease; myocardial scintigraphy; risk factors

Abbreviations: aCL, anticardiolipin; ACR, American College of Rheumatology; BMI, body mass index; CAD, coronary artery disease; CI, confidence interval; ECG, electrocardiography; HDL, high density lipoprotein; LDL, low density lipoprotein; MI, myocardial infarction; OR, odds ratio; SLE, systemic lupus erythematosus; SLEDAI, Systemic Lupus Erythematosus Disease Activity Index; SLICC/ACR-DI, Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index; SPECT, single photon emission computed tomography

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