Myocardial perfusion imaging in assessing risk of coronary events in patients with systemic lupus erythematosus.
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.


CONCLUSIONS
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.
Nikpour
Mandana
M
University of Toronto Lupus Clinic and the Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada.
Gladman
Dafna D
DD
Ibañez
Dominique
D
Bruce
Ian N
IN
Burns
Robert J
RJ
Urowitz
Murray B
MB
D000328:Adult; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D003326:Coronary Circulation / Q000502:physiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors