title: Myocardial perfusion imaging in Takayasu arteritis.
abstract: OBJECTIVE
  Myocardial perfusion defects using scintigraphy have been frequently observed in patients with Takayasu arteritis (TA) without coronary stenosis. The aim of our study was to evaluate coronary microcirculation in TA using thallium-201 (201Tl) myocardial scintigraphy and dipyridamole (DPM) as vasodilator agent.
  
  
  METHODS
  Twenty-five consecutive patients with TA were prospectively recruited. They were asymptomatic for cardiac issues and examined using 201Tl myocardial scintigraphy at rest and after coronary artery vasodilation with intravenous DPM. Factors associated with improvement in myocardial perfusion after DPM were identified in patients with TA.
  
  
  RESULTS
  Among 25 patients with TA, 21 (84%) had 201Tl myocardial perfusion defects and 4 (16%) had normal resting myocardial perfusion. Using a 17-segments model for quantitative image analysis, DPM significantly improved resting 201Tl myocardial perfusion in 14 patients (61%) versus 9 patients without improvement (39%). We were able to examine coronary artery stenoses in 11 patients, including 10 patients with thallium perfusion defects, and significant coronary artery stenoses were present in only 2 patients (18.2%). No significant difference was found in traditional cardiovascular risk factors between TA patients with or without improvement of myocardial perfusion after DPM. The absence of improvement in myocardial perfusion after DPM tended to be closely associated with specific features and prognostic factors of TA, such as aortic regurgitation at diagnosis, renovascular hypertension, longer duration of TA disease, and male sex.
  
  
  CONCLUSIONS
  We found the significantly high prevalence of myocardial perfusion defects mostly improved after vasodilation with DPM, which may indicate the major role of microcirculatory dysfunction in myocardial ischemia in TA.
authors.affiliation: From the Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié Salpétrière, Department of Internal Medicine, Université Pierre et Marie Curie; AP-HP, Groupe Hospitalier Saint-Antoine, Department of Nuclear Medicine, Université Pierre et Marie Curie; AP-HP, Hôpital Saint-Louis, Department of Biostatistics, Université Denis Diderot; AP-HP, Groupe Hospitalier Pitié Salpétrière, Department of Cardiology, Université Pierre et Marie Curie; AP-HP, Groupe Hospitalier Pitié Salpétrière, Department of Vascular Surgery, Université Pierre et Marie Curie, Paris, France.
authors.forename: Cloé
authors.initials: C
authors.lastname: Comarmond
authors.forename: Odile
authors.initials: O
authors.lastname: Dessault
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Devaux
authors.forename: Nathalie
authors.initials: N
authors.lastname: Costedoat-Chalumeau
authors.forename: Matthieu
authors.initials: M
authors.lastname: Resche-Rigon
authors.forename: Richard
authors.initials: R
authors.lastname: Isnard
authors.forename: Fabien
authors.initials: F
authors.lastname: Koskas
authors.forename: Patrice
authors.initials: P
authors.lastname: Cacoub
authors.forename: David
authors.initials: D
authors.lastname: Saadoun
mesh_terms: D000328:Adult; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D017023:Coronary Angiography; D003326:Coronary Circulation; D004176:Dipyridamole; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors; D013625:Takayasu Arteritis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D013793:Thallium; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; C027549:thallium chloride; D004176:Dipyridamole; D013793:Thallium
keywords: MICROCIRCULATION; MYOCARDIAL ISCHEMIA; SCINTIGRAPHY; TAKAYASU ARTERITIS; VASCULITIS