Single photon emission computed tomography dual isotope myocardial perfusion imaging in women with systemic lupus erythematosus. I. Prevalence and distribution of abnormalities

Objective. To determine the prevalence of myocardial perfusion abnormalitie s in women with systemic lupus erythematosus (SLE) using single photon emis sion computed tomography (SPECT) dual isotope myocardial perfusion imaging (DIMPI). Methods, Consecutive female patients registered at the University of Toront o Lupus Clinic were offered DIMPI evaluation and all who accepted were stud ied. Patients underwent SPECT DIMPI using dipyridamole stress. Resting and stress images were acquired using thallium-201 ((TI)-T-201) and technetium 99m-sestamibi (Tc-99m sestamibi), respectively. We recorded segmental perfu sion abnormalities, severity and reversibility of any abnormality, and numb er of vessel territories involved. Ejection fraction was also measured. Results. One hundred thirty patients were studied. Mean (SD) age and diseas e duration at study were 45.1 (11.1) years and 14.6 (9.4) years, respective ly. Thirteen patients (10%) had a history of angina pectoris or myocardial infarction. Overall, 52 (40%) patients had an abnormality of myocardial per fusion, including 11 (85%) with a history of angina or myocardial infarctio n. In those with no history of coronary artery disease, 41 (35%) had an abn ormality detected. The perfusion defect was reversible in 47 (90%). In 37 ( 71%) cases perfusion defects were seen in the region of a single vessel ter ritory. Eighteen (13.8%) patients had an ejection fraction (EF) < 50%. Conclusion, Using SPECT DIMPI, 40% of all women with SLE and 35% of women w ith SLE with no history of coronary artery disease had abnormalities of myo cardial perfusion, suggesting a high prevalence of early coronary artery di sease. The early detection of disease will facilitate study of atherosclero tic risk factors; such women can also be targeted for a focused program of risk factor management.