Five-Year Follow-Up of Coronary Microvascular Dysfunction and Coronary Artery Disease in Systemic Lupus Erythematosus: Results From a Community-Based Lupus Cohort

Objective The present study was undertaken to investigate prospective change in the prevalence of coronary microvascular dysfunction (CMD) and obstructive coronary artery disease (CAD) in a cohort of subjects with systemic lupus erythematosus (SLE) initially evaluated for anginal chest pain (CP). Prior work documented a relatively high prevalence ofCMDin the absence of obstructiveCADin subjects withSLE. Methods Twenty femaleSLEsubjects withCPwho underwent stress cardiac magnetic resonance imaging (CMRI) and coronary computed tomography angiography at baseline were reevaluated at 5 years. Results Seventeen subjects (85%) were available and reenrolled, of which 11 (65%) had persistentCPat follow-up. Fourteen subjects had complete follow-upCMRI, of which 36% (n = 5) demonstratedCMDat follow-up. Further, 25% (1 of 4) of the originally abnormal myocardial perfusion reserve index (MPRI) findings at baseline were lower at follow-up, while 2 additional abnormalMPRIfindings at follow-up were noted in previously normalMPRIresults. The prevalence ofCMDand nonobstructive/obstructiveCADboth was unchanged between baseline and follow-up, respectively (bothPvalues not significant). During follow-up, 33% of subjects (5 of 15) had adverse cardiac outcomes, including pericarditis, unstable angina, or intracranial aneurysm clipping procedure. Conclusion At the 5-year follow-up ofSLEsubjects withCPwho were evaluated at baseline and follow-up, a majority had persistentCP, and nearly one-half had similar or worse myocardial perfusion consistent withCMDwithout obstructiveCAD. These findings propose an alternative explanation forCPinSLEsubjects compared to the more commonSLE-related accelerated obstructiveCADaccounting forCPand adverse outcomes. These findings support further studies ofCMDas an etiology for cardiac morbidity and mortality inSLE.