ASSESSMENT OF MYOCARDIAL PERFUSION AND FUNCTION IN CHILDHOOD SYSTEMICLUPUS-ERYTHEMATOSUS

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 developmen t. Study design: Patients (n = 40; 30 female) were enrolled through th e Lupus Clinic at The Hospital for Sick Children between 1990 and 1992 . Resting and exercise thallium myocardial perfusion scans, radionucli de angiography with multiple gated acquisition (MUGA), and resting M-m ode and two-dimensional echocardiography were performed. Results: All patients were free of symptoms, and none bad a history of ischemic hea rt 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 (1 6%) of 31 patients (95% confidence interval: 3%, 29%) and included a l arge fixed perfusion defect in 1; 5 of 27 MUGA scans showed marginally low left ventricular ejection fractions at rest, whereas all had norm al exercise responses. In the group with abnormal thallium scans, thre e of five patients had antiphospholipid antibodies detected, and two o f four had an abnormal plasma lipid profile. This group tended to have a shorter disease duration and had received a lower cumulative dose o f corticosteroids; these differences were not statistically significan t compared with the group with normal scans. Conclusion: Asymptomatic abnormalities of myocardial perfusion occur in children with SLE and a re more common than previously suspected. Patients with these abnormal ities of myocardial perfusion may be predisposed to the previously rec ognized early-onset ischemic heart disease seen in adults with SLE.