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Coronary Microvascular Dysfunction in Patients With Systemic Lupus Erythematosus and Chest Pain

Ashley S Manchanda1, Alan C Kwan2,3,4, Mariko Ishimori5

  • 1Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.

Frontiers in Cardiovascular Medicine
|May 2, 2022
PubMed

Insights

Systemic lupus erythematosus (SLE) patients with chest pain often have ischemia with no obstructive coronary arteries (INOCA). Coronary microvascular dysfunction is common in these patients, requiring specific diagnostic approaches.

Area of Science:

  • Cardiology
  • Rheumatology
  • Vascular Medicine

Background:

  • Systemic lupus erythematosus (SLE) is an autoimmune disease linked to heightened cardiovascular risks.
  • Chest pain is a frequent symptom in SLE patients, often stemming from complex, multifactorial causes.
  • Non-obstructive coronary artery disease is increasingly recognized as a cause of chest pain in SLE.

Purpose of the Study:

  • To review cardiovascular risk assessment in SLE patients presenting with chest pain.
  • To explore the mechanisms underlying ischemia with no obstructive coronary arteries (INOCA) in SLE.
  • To outline diagnostic strategies for SLE patients with suspected coronary microvascular dysfunction (CMD).

Main Methods:

  • Literature review focusing on cardiovascular aspects of SLE.
  • Analysis of studies investigating INOCA and CMD in SLE cohorts.
  • Synthesis of current guidelines and emerging evidence on diagnosis and management.

Main Results:

  • INOCA is prevalent in SLE patients with chest pain and non-obstructive coronary arteries.
  • Coronary microvascular dysfunction affects approximately 50% of SLE patients with suspected INOCA.
  • Multifactorial etiologies contribute to chest pain in SLE, including CMD.

Conclusions:

  • SLE patients with chest pain warrant thorough cardiovascular evaluation, considering INOCA and CMD.
  • Early identification and management of CMD are crucial for improving cardiovascular outcomes in SLE.
  • Further research is needed to refine diagnostic and therapeutic strategies for INOCA/CMD in SLE.

Keywords:
chest paincoronary microvascular dysfunctioncoronary vasospasmischemic heart diseasesystemic lupus erythematosus

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