Abstract 10923: Myocardial Perfusion Reserve Measured by Adenosine Stress Magnetic Resonance Imaging in Systemic Lupus Erythematosus Patients with Angina but No Coronary Artery Disease
Background: We have previously demonstrated that visually assessed adenosine stress perfusion cardiac magnetic resonance imaging (CMRI) is frequently abnormal in patients with Systemic Lupus Erythematosus (SLE) and symptoms of angina in the absence of obstructive coronary artery disease (CAD). Objectives CMRI measures including quantitative assessment myocardial perfusion reserve index (MPRI) have not been evaluated in this setting.
Methods: CMRI at 1.5 Tesla was performed in 18 women (age 41.4±10.5 years) with low to moderate SLE disease activity index (SLEDAI) and angina but no obstructive CAD by computed tomography, and in 10 asymptomatic reference control group women (mean age 53.2±5 years, p=0.001). CMRI was performed using a standardized protocol with 0.05mmol/kg gadolinium adenosine stress followed by rest perfusion imaging in three short axis slices. First pass perfusion images where analyzed in whole, subepicardial and subendocardial regions by PIE medical software (Netherlands). MPRI was calculated as the ratio of stress/rest relative upslope, corrected for left ventricular input. Univariate and multivariate linear analysis were performed.
Results: All patients and controls had normal cardiac structure and left ventricular systolic function. Mean MPRI in patients versus controls was reduced in all three myocardial regions (Table1). Multivariate linear regression revealed that the presence of SLE was the only predictor of subepicardial (p<0.0025, β:-1.059) and subendocardial (p<0.05, β:-0.529) MPRI.
Conclusion: Among SLE patients with angina but no obstructive CAD, reduced MPRI measured by CMRI is observed compared to controls, and SLE predicts abnormal MPRI. These findings suggest that further investigation is warranted in this population to test the hypothesis that angina in SLE patients but no obstructive CAD is due to myocardial ischemia related to microvascular coronary dysfunction.
- © 2010 by American Heart Association, Inc.