RT Journal Article
SR Electronic
T1 Myocardial Perfusion Imaging in Assessing Risk of Coronary Events in Patients with Systemic Lupus Erythematosus
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.080776
DO 10.3899/jrheum.080776
A1 Mandana Nikpour
A1 Dafna D.  Gladman
A1 Dominique  Ibañez
A1 Ian N.  Bruce
A1 Robert J.  Burns
A1 Murray B.  Urowitz
YR 2009
UL http://www.jrheum.org/content/early/2009/01/22/jrheum.080776.abstract
AB Objective Classic risk factors do not fully account for the increased risk of coronary artery disease (CAD) in systemic lupus erythematosus (SLE), making identification of the subset of patients at risk challenging. In this prospective cohort study we investigated whether myocardial perfusion defects in SLE are predictive of CAD events, independently of traditional Framingham risk factors. Methods We performed myocardial perfusion imaging in 122 women with SLE who did not have a history of CAD. Patients had clinical and serologic evaluation, and an assessment of cardiac risk factors. They were then followed for the occurrence of CAD events. Cox regression models were used to determine independent predictors of CAD. Results Forty-six (37.7%) patients had perfusion defects. Median followup was 8.7 years, during which 15 CAD events occurred (1 myocardial infarction, 14 angina). Cox modeling showed that myocardial perfusion defects are strongly predictive of CAD [hazard ratio (HR) 13.0, 95% CI 2.8 to 60.1, p = 0.001]. Although the 10-year Framingham risk score was significantly predictive of CAD (HR 1.8, 95% CI 1.1 to 2.9, p = 0.01), the risk scores in groups with normal and abnormal scans were similar to the “low-risk” general population. Conclusion In women with SLE, myocardial perfusion defects are strongly and independently predictive of CAD. Our findings suggest that myocardial perfusion imaging to assess risk of future coronary events should be considered in women with SLE.