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Official Journal of the , the International Union of Phlebology and the
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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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.