系统性红斑狼疮中的心肌缺血：检测与临床相关性。

Myocardial ischaemia in systemic lupus erythematosus: detection and clinical relevance.

机构信息

Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland.

出版信息

Kardiol Pol. 2011;69(11):1129-36.

PMID:22090220

Abstract

BACKGROUND

Severe cardiovascular complications are among the most important causes of mortality in systemic lupus erythematosus (SLE) patients.

AIM

To assess the usefulness of echocardiography, ECG, and coronary artery calcium scoring (CACS) in the detection of myocardial ischaemia in SLE patients compared to single photon emission computerised tomography (SPECT) and to assess their five-year follow-up.

METHODS

In 50 consecutive SLE patients (mean age 39.2 ± 12.9 years, 90% female), clinical assessment, resting and exercise ECG and echocardiography, multidetector computed tomography - based CACS and SPECT studies (Tc-99m sestamibi) were performed. Patients were then followed for five years.

RESULTS

SPECT revealed perfusion defects in 25 (50%) patients; persistent defects in 18 (36%) and exercise-induced defects in seven (14%) subjects. No typical ischaemic heart disease clinical symptoms, signs of ischaemia in resting ECG, or left ventricular contractility impairment in echocardiography were observed. Signs of ischaemia in exercise ECG were found in 17 (34%) patients. The CACS ranged from 1 to 843.2 (median 23.15), and coronary calcifications were observed in 12 (24%) patients. Compared to the SPECT study, exercise ECG had 68% sensitivity and 100% specificity in detecting myocardial ischaemia, while CACS had only 28% sensitivity and 58% specificity. During follow-up, one patient who showed myocardial perfusion defects and the highest calcium score (843.2) at baseline, developed CCS II class symptoms of myocardial ischaemia. Coronary angiography was not performed because of severe anaemia; the patient died three months later. In two other patients with perfusion defects and calcium deposits at baseline, CCS I class symptoms were observed; coronary angiography showed only thin calcified coronary plaques that were haemodynamically insignificant.

CONCLUSIONS

In about half of relatively young, mostly female, SLE patients, SPECT shows myocardial perfusion defects, with coronary calcifications present in one quarter of them. While ECG and echocardiography may not reveal any pathology, ECG exercise test can identify these patients with high specificity. In patients with a negative SPECT, the short-term prognosis is good, while in patients with perfusion defects and coronary calcifications, the clinical symptoms of myocardial ischaemia could occurr. However, at a low calcium score ( < 150), the short-term risk of significant atherosclerosis progression is low.

摘要

背景

严重心血管并发症是系统性红斑狼疮（SLE）患者死亡的最重要原因之一。

目的

评估超声心动图、心电图和冠状动脉钙评分（CACS）在检测 SLE 患者心肌缺血方面的效用，与单光子发射计算机化断层扫描（SPECT）相比，并评估其五年随访结果。

方法

对 50 例连续的 SLE 患者（平均年龄 39.2±12.9 岁，90%为女性）进行临床评估、静息和运动心电图及超声心动图、多排 CT 基础 CACS 和 SPECT 研究（Tc-99m sestamibi）。然后对患者进行五年随访。

结果

SPECT 显示 25 例（50%）患者存在灌注缺损；18 例（36%）为持续性缺损，7 例（14%）为运动诱导性缺损。未观察到典型的缺血性心脏病临床症状、静息心电图缺血迹象或超声心动图左心室收缩功能障碍。17 例（34%）患者出现运动心电图缺血迹象。CACS 范围为 1 至 843.2（中位数 23.15），12 例（24%）患者存在冠状动脉钙化。与 SPECT 研究相比，运动心电图在检测心肌缺血方面的敏感性为 68%，特异性为 100%，而 CACS 的敏感性仅为 28%，特异性为 58%。在随访期间，一名基线时显示心肌灌注缺损和最高钙评分（843.2）的患者出现了 CCS II 类心肌缺血症状。由于严重贫血未进行冠状动脉造影，患者三个月后死亡。另外两名基线时存在灌注缺损和钙沉积的患者出现了 CCS I 类症状；冠状动脉造影显示仅存在细小的钙化冠状动脉斑块，对血流动力学无影响。

结论

在大约一半相对年轻、主要为女性的 SLE 患者中，SPECT 显示心肌灌注缺损，其中四分之一存在冠状动脉钙化。尽管心电图和超声心动图可能没有发现任何病理学变化，但心电图运动试验可以识别出这些具有高特异性的患者。在 SPECT 阴性的患者中，短期预后良好，而在存在灌注缺损和冠状动脉钙化的患者中，可能会出现心肌缺血的临床症状。然而，在低钙评分（<150）时，短期内发生严重动脉粥样硬化进展的风险较低。