Abstract 2948: Evidence of Coronary Microvascular Dysfunction in patients with Systemic Inflammatory Diseases

Abstract

Purpose: Accelerated coronary disease is a leading cause of morbidity and mortality in patients (pts) suffering from immune-mediated inflammatory diseases (IMID), such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). We tested the hypothesis that inflammation, in the absence of conventional cardiovascular risk factors, could result in coronary microvascular dysfunction (CMD) which is known to precede atherosclerosis in large vessels in pts with cardiovascular risk factors. Methods: Myocardial blood flow (MBF, ml/min/g) was measured using positron emission tomography at rest and during i.v. adenosine (140 μg/Kg/min) in 8 SLE and 10 RA pts aged 47 ± 8 years without conventional cardiovascular risk factors and in 18 age and gender matched controls. In pts multislice (64 slices) CT coronary angiography was performed to exclude coronary stenoses. Results: Mean disease duration was 18 ± 11 and 14 ± 6 years in RA and SLE respectively. There was no difference in resting MBF between pts and controls (1.27 ± 0.25 vs 1.11 ± 0.23; p=0.06). However, adenosine MBF was diffusely reduced in pts compared with controls (2.72 ± 0.84 vs 4.20 ± 0.75; p<0.0001) (Figure ). Coronary flow reserve (CFR; adenosine/resting MBF) was significantly reduced in pts (2.24 ± 0.74) compared with controls (4.00 ± 0.83; p<0.0001). Six pts showed ECG changes during adenosine stress and had a more severe reduction in CFR (1.73 ± 0.88) compared with those without ECG changes (2.49 ± 0.54; p<0.006). Conclusions: Patients with IMID and without conventional cardiovascular risk factors have evidence of CMD which can result in reductions of CFR severe enough to cause myocardial ischemia.