Estudo de perfusão miocárdica e cineangiocoronariografia em pacientes com lúpus eritematoso sistêmico
OBJECTIVE: To evaluate coronary artery findings using coronary artery angiography in systemic lupus erythematosus (SLE) patients with myocardial perfusion abnormalities. METHODS: Ninety female SLE patients, ages from 18 to 55 years old, more than 5 years of disease duration, without current or previ...
| Autores: | , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2004 |
| País: | Brasil |
| Institución: | Universidade Federal de São Paulo (UNIFESP) |
| Repositorio: | Repositório Institucional da UNIFESP |
| Idioma: | portugués |
| OAI Identifier: | oai:repositorio.unifesp.br:11600/2189 |
| Acceso en línea: | http://dx.doi.org/10.1590/S0482-50042004000400004 http://repositorio.unifesp.br/handle/11600/2189 |
| Access Level: | acceso abierto |
| Palabra clave: | systemic lupus erythematosus coronary artery disease risk factors myocardial scintigraphy coronary angiography lúpus eritematoso sistêmico doença arterial coronária fatores de risco cintilografia miocárdica cineangiocoronariografia |
| Sumario: | OBJECTIVE: To evaluate coronary artery findings using coronary artery angiography in systemic lupus erythematosus (SLE) patients with myocardial perfusion abnormalities. METHODS: Ninety female SLE patients, ages from 18 to 55 years old, more than 5 years of disease duration, without current or previous confirmed coronary artery disease (CAD), and who were either in use or had used steroid treatment for at least 1 year were evaluated. Myocardial perfusion scintigraphy was performed using a singlephoton emission computed tomography employing Technetium 99m-sestamibi. Images were captured at resting and after dipyridamole-induced stress. The CAD risk factors (RF) considered were the traditional ones in general population and SLE-related factors. All patients who had abnormal findings on myocardial perfusion tests were invited to undergo coronary angiography. RESULTS: The mean age was 38 ± 10 years old, with mean disease duration of 128 ± 59 months, American College of Rheumatology (ACR) number 7 ± 1, Disease Activity Index for SLE (SLE-DAI) score 6 ± 5 and Systemic Lupus International Collaborating Clinics/ACR Damage Index for SLE (SLICC/ACR-DI) score 2 ± 2. Thirty-three percent of patients presented myocardial perfusion scintigraphy abnormalities. Regression logistic analysis was performed considering the traditional CAD-RF and SLE-related variables in 48 SLE patients on regular follow-up. Current vasculitis was associated with abnormal myocardial perfusion. There was no association between other clinical and/or serologic features, cumulative dose or duration of prednisone use and myocardial perfusion scintigraphy results. Twenty-one patients with abnormal myocardial scintigraphy agreed to undergo coronary angiography. Atherosclerotic plaques were identified by angiography in eight patients (38%). Abnormal angiography subgroup presented higher number of traditional CAD-RF (p = 0.006). Arterial hypertension, postmenopausal status and higher triglyceride level showed a significant association with abnormal angiography (p = 0.046, 0.024 and 0.043, respectively). The number of ACR criteria, SLE-DAI and SLICC/ACR-DI scores were also higher in the sub-group with coronary abnormalities (p = 0.018, 0.010 and 0.003, respectively). CONCLUSIONS: Current vasculitis was an important variable associated with abnormal myocardial scintigraphy. This study suggests that myocardial scintigraphy can be used as a screening test for CAD in SLE patients with high-risk of cardiovascular disease, even in the absence of ischemic heart symptoms. Patients with abnormal myocardial perfusion results and at least four CAD-RF had higher risk of presenting coronary stenosis on coronary angiography. |
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