Objectives To study frequency and character of atherosclerotic damage of coronary arteries (CA) and associated coronary heart disease (CHD) in patients (pts) with systemic lupus erythematosus (SLE); to suggest a rational algorithm of non-invasive diagnostics CHD in this category of pts.
Methods We studied autopsy protocols and case histories of 33 pts who died of SLE (26 women and 7 men, the mean age 39.7±2.6 years, the mean disease duration – 81.3±17.4 month). 100 pts with SLE were examined intravital (90 women and 10 men) aged from 18 to 66 years old (mean 40,9±1,4), the disease duration – from 1 to 43 years (mean 9.93±0.88 years). For detection of CA calcification we used multidetector computed tomography (MDCT) with calculation of calcium index (CI) and Mayo scale. In order to diagnose CHD we used both traditional clinical examination and stress tests – treadmill-test and stress echocardiography with dipyridamole. Diagnosis of CHD was set if not less than two informative methods of investigation were positive – MDCT (obligatory) and one of the stress tests.
Results Among patients who died, the signs of aortic atherosclerosis (AS) were found in 51,5% of people, AS CA – in 39,4%, the CA stenosis – in 21,2%. One patient had intravital CHD signs. MDCT data detected calcification of CA in 39% of pts with SLE during their lifetime with mean CI 52,6±11,4 (mild calcification). Atherosclerotic plaques were most frequently localized in the left main artery (66,7% from 39), more rarely – in the left anterior descending artery (51,3%), and occasionally – in the left circumflex and right CA (12,8% and 10,3% respectively). Damage of several CA was observed in 14 pts: 2 – in 12, 3 – in 2 pts. Moderate degree of calcification was registered in 10 pts, high – in no-one. Degree of calcification (mean CI) CA diminished in the following sequence: left anterior descending > left main > right > left circumflex.
Treadmill-test was performed by 94 pts, other 6 pts didn’t perform it due to stable changes of ST-segment. The test was informative in 55,3% cases (negative in 43 pts, positive in 9 – an ischemic ST-segment depression), noninformative – in 44,7% cases (due to low tolerance to the physical loadings). Out of pts with noninformative treadmill-test and those who didn’t perform it (in total 48%) 26 pts agreed to undergo stress echocardiography. The test appeared negative in 13 pts, positive – in 12, noninformative - in 1.
Among 39 pts with CA calcification treadmill-test was positive in 8 pts, negative – in 10, noninformative – in 17; positive result of stress echocardiography was established in 12 pts, negative – in 3. The diagnosis of CHD was set in 21 pts (53,8% from the number of all pts with AS CA according to MDCT). Clinical signs of CHD were present in 11 pts (effort angina – in 10 pts, remote myocardial infarction – in 6 pts, 5 of whom had an angina pectoris).
Conclusions AS CA was found in 39,4% SLE pts at autopsy and in 39% pts – intravital. For timely detection of CHD in pts with SLE we recommend such algorithm: MDCT may be used as a screening test for diagnostics of AS CA; in pts with positive results of MDCT stress echocardiography is more preferable in diagnostics of CHD, since informativity of pharmacological test achieves 96,2%, whereas the treadmill-test’s is only 55,3%.
Disclosure of Interest None Declared
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