BACKGROUND: Systemic lupus erythematosus (SLE) patients can frequently present cardiac symptoms, however its etiology is not well known. EXPERIMENTAL DESIGN: prospective study. SETTINGS: specialized out-patient unit for SLE patients at an university hospital. PATIENTS: 15 SLE patients (13 females, 2 males; age range 18-64 years). INTERVENTIONS: metabolic studies of the heart were done using 18F-deoxy-glucose (18FDG, 296-333 MBq on a 2-head hybrid system) as well as heart perfusion studies (111MBq 201Tl). Additional studies: resting ECG, echocardiography, stress ECG, immunological activity parameters, antibody analyses (ANA, ENA, anti-cardiolipin antibodies), CPK, troponin-T, and lipid profiles. MEASURES: degree of correlation between conventional diagnostics and the imaging techniques. RESULTS: Abnormal ECG in 10 cases, pericardial involvement in 11 cases, elevated CPK in 1 case. ANTIBODY PROFILES: anti-cardiolipin in 10/15, ENA in 9/15, ANA in 14/15. None of these changes were associated with parameters of immune activation. In the majority of cases (10/15) the 18FDG scan showed a speckled, inhomogeneous pattern of distribution, which contrasted sharply with a normal 201Tl scan. A similar pattern was observed in the patients with ocular mitochondrial myopathy, the anti-phospholipid syndrome as well as in dermatomyositis. CONCLUSIONS: Our preliminary results suggest that SLE patients with cardiac symptoms may have an abnormal glucose metabolism of the myocardium as shown by a pathological 18FDG scan, whereas perfusion appears to be normal (reversed mismatch). The lack of correlation with acute elevation of cardiac enzymes or with ECG changes suggest a chronic process.
BACKGROUND:Systemic lupus erythematosus (SLE) patients can frequently present cardiac symptoms, however its etiology is not well known. EXPERIMENTAL DESIGN: prospective study. SETTINGS: specialized out-patient unit for SLEpatients at an university hospital. PATIENTS: 15 SLEpatients (13 females, 2 males; age range 18-64 years). INTERVENTIONS: metabolic studies of the heart were done using 18F-deoxy-glucose (18FDG, 296-333 MBq on a 2-head hybrid system) as well as heart perfusion studies (111MBq 201Tl). Additional studies: resting ECG, echocardiography, stress ECG, immunological activity parameters, antibody analyses (ANA, ENA, anti-cardiolipin antibodies), CPK, troponin-T, and lipid profiles. MEASURES: degree of correlation between conventional diagnostics and the imaging techniques. RESULTS: Abnormal ECG in 10 cases, pericardial involvement in 11 cases, elevated CPK in 1 case. ANTIBODY PROFILES: anti-cardiolipin in 10/15, ENA in 9/15, ANA in 14/15. None of these changes were associated with parameters of immune activation. In the majority of cases (10/15) the 18FDG scan showed a speckled, inhomogeneous pattern of distribution, which contrasted sharply with a normal 201Tl scan. A similar pattern was observed in the patients with ocular mitochondrial myopathy, the anti-phospholipid syndrome as well as in dermatomyositis. CONCLUSIONS: Our preliminary results suggest that SLEpatients with cardiac symptoms may have an abnormal glucose metabolism of the myocardium as shown by a pathological 18FDG scan, whereas perfusion appears to be normal (reversed mismatch). The lack of correlation with acute elevation of cardiac enzymes or with ECG changes suggest a chronic process.
Authors: Sophie I Mavrogeni; George Markousis-Mavrogenis; David Heutemann; Kees van Wijk; Hans J Reiber; Genovefa Kolovou Journal: World J Methodol Date: 2015-09-26