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Coronary Artery Disease (CAD) is a primary health risk worldwide, leading to significant morbidity and mortality. The condition arises from the buildup of atherosclerotic plaques within the coronary arteries, resulting in diminished blood supply to the heart muscle.The clinical manifestations of CAD vary widely, from asymptomatic stages to severe, life-threatening conditions. Understanding these manifestations is crucial for early diagnosis and effective management.Angina Pectoris: The Warning...
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Coronary Microvascular Dysfunction in Systemic Lupus Erythematosus.

Brittany N Weber1,2, Emma Stevens3, Leanne Barrett2

  • 1Division of Cardiovascular Medicine Department of MedicineBrigham and Women's HospitalHarvard Medical SchoolBoston MA.

Journal of the American Heart Association
|June 16, 2021
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Summary

Systemic lupus erythematosus (SLE) patients exhibit coronary microvascular dysfunction (CMD) independent of atherosclerosis. This study found SLE is linked to reduced myocardial flow reserve, indicating a higher cardiovascular risk in these patients.

Keywords:
coronary microvascular dysfunctioninflammationsystemic lupus erythematosus

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Area of Science:

  • Cardiology
  • Rheumatology
  • Nuclear Medicine

Background:

  • Systemic lupus erythematosus (SLE) is linked to premature atherosclerosis and increased cardiovascular risk.
  • Systemic inflammation in SLE is an emerging risk factor for coronary microvascular dysfunction (CMD).

Purpose of the Study:

  • To determine if CMD, defined by abnormal myocardial flow reserve (MFR), is independently associated with SLE.
  • To adjust for nonobstructive atherosclerotic burden and common cardiovascular risk factors.

Main Methods:

  • Included 42 SLE patients undergoing stress cardiac positron emission tomography-computed tomography (PET-CT).
  • Excluded obstructive coronary artery disease and systolic dysfunction.
  • Defined CMD as MFR <2 and compared with 69 matched controls.

Main Results:

  • SLE patients showed significantly reduced global MFR compared to controls (1.91±0.5 vs 2.4±0.7, P<0.0001).
  • Prevalence of CMD was higher in SLE patients (57.1% vs 33.3%, P=0.017).
  • These differences persisted despite similar nonobstructive atherosclerotic burden between groups.

Conclusions:

  • Patients with SLE and cardiac symptoms have a high prevalence of coronary vasomotor abnormalities.
  • SLE is independently associated with reduced MFR, suggesting CMD is a key factor in SLE-related cardiovascular risk.
  • Reduced MFR in SLE is not explained by common cardiovascular risk factors or atherosclerotic burden.