Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Apr 15:9:867155.
doi: 10.3389/fcvm.2022.867155. eCollection 2022.

Coronary Microvascular Dysfunction in Patients With Systemic Lupus Erythematosus and Chest Pain

Ashley S Manchanda  1 , Alan C Kwan  2   3   4 , Mariko Ishimori  5 , Louise E J Thomson  4 , Debiao Li  3 , Daniel S Berman  2   3   4 , C Noel Bairey Merz  1   2 , Caroline Jefferies  5 , Janet Wei  1   2   3
Affiliations
Review

Coronary Microvascular Dysfunction in Patients With Systemic Lupus Erythematosus and Chest Pain

Ashley S Manchanda et al. Front Cardiovasc Med. .

Abstract

Chest pain is a common symptom in patients with systemic lupus erythematosus, an autoimmune disease that is associated with increased cardiovascular morbidity and mortality. While chest pain mechanisms can be multifactorial and often attributed to non-coronary or non-cardiac cardiac etiologies, emerging evidence suggests that ischemia with no obstructive coronary arteries (INOCA) is a prevalent condition in patients with chest pain and no obstructive coronary artery disease. Coronary microvascular dysfunction is reported in approximately half of SLE patients with suspected INOCA. In this mini review, we highlight the cardiovascular risk assessment, mechanisms of INOCA, and diagnostic approach for patients with SLE and suspected CMD.

Keywords: chest pain; coronary microvascular dysfunction; coronary vasospasm; ischemic heart disease; systemic lupus erythematosus.

PubMed Disclaimer

Conflict of interest statement

CB has served as consultant for Sanofi, Abbott Diagnostics, and iRhythm. DB has served as a consultant for Bayer and received software royalties from Cedars-Sinai Medical Center. JW has served as consultant and advisory board member for Abbott Vascular. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Inflammatory mechanisms driving coronary vascular dysfunction in SLE. Lupus-specific and non-lupus specific factors drive inflammation and coronary vascular dysfunction in SLE. IFNs indicate interferons; MCP-1, monocyte chemoattractant protein 1; NET, neutrophil extracellular trap; ROS, reactive oxygen species. [Created in Biorender. Adapted from (43)].
Figure 2
Figure 2
Clinical risk assessment of SLE patients with chest pain and algorithm for diagnosis of coronary microvascular dysfunction and vasospasm. Non-invasive and invasive testing allow assessment of coronary microvascular dysfunction, while invasive acetylcholine provocation testing can additionally assess coronary vasospasm. While CMR may be preferred for concomitant assessment of myocarditis, test choice should be guided by local expertise and availability. All SLE patients with angina should receive optimal medical therapy, including lifestyle intervention and intensive pharmacologic therapy (anti-ischemic and preventive therapy). CAD indicates coronary artery disease; CFR, coronary flow reserve; CMR, cardiac magnetic resonance imaging; CVD, cardiovascular disease; ECG, electrocardiogram; FFR, fractional flow reserve; IMR, index of microcirculatory restriction; MFR, myocardial flow reserve; MPRI, myocardial perfusion reserve index; PET, positron emission tomography; and TTDE, transthoracic doppler echocardiography.
See this image and copyright information in PMC

References

    1. Yurkovich M, Vostretsova K, Chen W, Avina-Zubieta JA. Overall and cause-specific mortality in patients with systemic lupus erythematosus: a meta-analysis of observational studies. Arthritis Care Res. (2014) 66:608–16. 10.1002/acr.22173 - DOI - PubMed
    1. Aggarwal NR, Patel HN, Mehta LS, Sanghani RM, Lundberg GP, Lewis SJ, et al. . Sex differences in ischemic heart disease: advances, obstacles, and next steps. Circ Cardiovasc Qual Outcomes. (2018) 11:e004437. 10.1161/CIRCOUTCOMES.117.004437 - DOI - PubMed
    1. Ward MM. Premature morbidity from cardiovascular and cerebrovascular diseases in women with systemic lupus erythematosus. Arthritis Rheum. (1999) 42(2):338–46. 10.1002/1529-0131(199902)42:2<338::AID-ANR17>3.0.CO;2-U - DOI - PubMed
    1. Manzi S, Meilahn EN, Rairie JE, Conte CG, Medsger TA, Jansen-McWilliams L, et al. . Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the framingham study. Am J Epidemiol. (1997) 145:408–15. 10.1093/oxfordjournals.aje.a009122 - DOI - PubMed
    1. Ishimori ML, Gal NJ, Rogatko A, Berman DS, Wilson A, Wallace DJ, et al. . Prevalence of angina in patients with systemic lupus erythematosus. Arthritis Res Ther. (2012) 14:A62. 10.1186/ar3996 - DOI

LinkOut - more resources