Objective: To detect coronary artery disease in asymptomatic patients with systemic lupus erythematosus and scleroderma associated with pulmonary hypertension, and to determine whether it is focal or diffuse ischemia.
Methods: Twenty patients with systemic lupus erythematosus (10 with pulmonary hypertension and 10 without), and 20 patients with scleroderma (10 with pulmonary hypertension and 10 without) were included in this study. Resting ECG, echocardiography, and stress-rest 99mTc sestamibi gated myocardial perfusion imaging were performed for all patients. Patients with ischemia were subjected to coronary angiography to exclude/confirm coronary artery lesions.
Results: Myocardial perfusion SPECT showed that seven patients had myocardial ischemia, including three (30%) of 10 with systemic lupus erythematosus and pulmonary hypertension, three (30%) of 10 with scleroderma and pulmonary hypertension, and one (10%) of 10 with systemic lupus erythematosus without pulmonary hypertension. There was a high incidence of positive myocardial perfusion defects among patients with pulmonary hypertension than those without. Normal coronary angiography was found in all patients with ischemia, except for only one patient with scleroderma who had coronary artery stenosis. Significant correlation was found between pulmonary artery diameter obtained by echocardiography and severity of LV myocardial ischemia detected by SPECT (r=0.83). Significant correlation was found between SPECT-detected myocardial ischemia and ECG ST-T segment changes (r=0.82).
Conclusion: Coronary artery disease is a common association in patients with systemic lupus erythematosus and scleroderma, especially in those with pulmonary hypertension. This may reflect anatomical compression by distended pulmonary artery rather than diffuse ischemia or small vessel disease. It is important to determine the presence of coronary artery disease in these patients, which may be amenable to coronary stenting.
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