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A Journal on Angiology

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2001 December;20(4):314-21


language: English

Detection of myocardial involvement in systemic lupus erythematosus: mismatch between normal perfusion scans with 201Thallium and pathological 18FDG uptake

Moncayo R., Kowald E. 1, Schauer N. 2, Pachinger O. 2, Schmuth M. 1, Fritsch P. 1, Riccabona G., Sepp N. 1

From the Departments of Nuclear Medicine, 1 Dermatology and 2 Cardiology, University of Innsbruck, Innsbruck, Austria


Back­ground. System­ic lupus ery­them­a­to­sus (SLE) ­patients can fre­quent­ly ­present car­diac symp­toms, how­ev­er its eti­ol­o­gy is not well known.
Meth­ods. Experi­men­tal ­design: pros­pec­tive study. Set­ting: 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.

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