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Assessment of myocardial perfusion and function in childhood systemic lupus erythematosus
M Gazarian1, B M Feldman, L N Benson
1Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada.
Insights
Asymptomatic myocardial perfusion abnormalities are common in children with systemic lupus erythematosus (SLE), potentially predicting early-onset heart disease. Further research is needed to identify predictive factors for these cardiac issues in pediatric SLE patients.
Area of Science:
- Pediatric Cardiology
- Rheumatology
- Cardiovascular Imaging
Background:
- Systemic lupus erythematosus (SLE) can affect multiple organ systems, including the cardiovascular system.
- Early detection of cardiac involvement in pediatric SLE is crucial for long-term outcomes.
- Previous studies have not fully elucidated the prevalence and predictors of myocardial abnormalities in this population.
Purpose of the Study:
- To determine the prevalence of myocardial perfusion and function abnormalities in children diagnosed with SLE.
- To identify potential clinical or laboratory factors that may predict the development of these cardiac abnormalities.
Main Methods:
- A cohort of 40 children with SLE was enrolled between 1990 and 1992.
- Cardiovascular assessments included resting and exercise thallium myocardial perfusion scans, radionuclide angiography (MUGA), and echocardiography.
- Data on patient demographics, disease characteristics, and laboratory findings were collected.
Main Results:
- Abnormalities in coronary perfusion were detected in 16% of patients.
- Marginally low resting left ventricular ejection fractions were observed in 5 out of 27 MUGA scans.
- Patients with perfusion abnormalities showed a higher prevalence of antiphospholipid antibodies and abnormal plasma lipid profiles.
Conclusions:
- Asymptomatic myocardial perfusion abnormalities are more prevalent in children with SLE than previously recognized.
- These findings suggest a potential predisposition to early-onset ischemic heart disease in pediatric SLE patients.
- Further investigation is warranted to understand the predictive factors and long-term implications of these cardiac abnormalities.
Objectives:
To determine the prevalence of abnormalities in myocardial perfusion or function in children with systemic lupus erythematosus (SLE), and describe potential factors that may predict their development.
Study Design:
Patients (n = 40; 30 female) were enrolled through the Lupus Clinic at The Hospital for Sick Children between 1990 and 1992. Resting and exercise thallium myocardial perfusion scans, radionuclide angiography with multiple gated acquisition (MUGA), and resting M-mode and two-dimensional echocardiography were performed.
Results:
All patients were free of symptoms, and none had a history of ischemic heart disease. Their median age was 15.9 years (range 10.5 to 19.8 years) at enrollment. Abnormalities of coronary perfusion were found in 5 (16%) of 31 patients (95% confidence interval: 3%, 29%) and included a large fixed perfusion defect in 1; 5 of 27 MUGA scans showed marginally low left ventricular ejection fractions at rest, whereas all had normal exercise responses. In the group with abnormal thallium scans, three of five patients had antiphospholipid antibodies detected, and two of four had an abnormal plasma lipid profile. This group tended to have a shorter disease duration and had received a lower cumulative dose of corticosteroids; these differences were not statistically significant compared with the group with normal scans.
Conclusion:
Asymptomatic abnormalities of myocardial perfusion occur in children with SLE and are more common than previously suspected. Patients with these abnormalities of myocardial perfusion may be predisposed to the previously recognized early-onset ischemic heart disease seen in adults with SLE.