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Coronary Vessel Wall Contrast Enhancement Imaging as a Potential Direct Marker of Coronary Involvement: Integration of Findings From CAD and SLE Patients
Study Questions:
Is there a difference in coronary wall contrast enhancement (CE) by cardiac magnetic resonance (CMR) imaging between patients with systemic lupus erythematosus (SLE), coronary artery disease (CAD), and controls?
Methods:
Study investigators performed CMR in 75 subjects (25 with CAD, 27 with SLE, 23 controls), and compared patterns of coronary CE using CMR. Proximal coronary arteries were assessed visually for CE and using quantitative measures.
Results:
Mean ages were 44 ± 14, 42 ± 16, and 59 ± 9 years for controls and those with SLE and CAD (p < 0.01); female gender was present in 64%, 85%, and 64% of patients, respectively (p = 0.02). For controls and patients with SLE and CAD, patchy CE was noted in 13%, 11%, and 76% (p < 0.001), while generalized CE was present in 4%, 89%, and 24%, respectively (p < 0.001). Between these groups (controls vs. SLE vs. CAD), there were differences in moderate or severe CE intensity (0% vs. 89% vs. 92%, p = 0.002), contrast-to-noise ratio (2.9 ± 2.5 vs. 6.9 ± 2.5 vs. 6.8 ± 2.0, p < 0.001), and CE area (0.8 vs. 3.2 vs. 3.3 mm3, p < 0.001). Both increased contrast-to-noise ratio and CE area were associated positively with aortic stiffness (r = 0.61 and 0.32).
Conclusions:
The authors concluded that patients with SLE and CAD have increased coronary artery CE on CMR as compared to controls.
Perspective:
There are several imaging techniques that can identify patients with subclinical cardiovascular disease, including coronary artery calcium scoring, coronary computed tomography angiography, and positron emission tomography. In contrast to those modalities, CMR uses no ionizing radiation, and may therefore represent a safer means to assess for subclinical atherosclerosis. CE correlates with the presence of coronary artery scar, fibrosis, and edema, and may indicate acute and/or chronic inflammation. This feasibility study observes a striking difference in the presence and patterns of CE between controls and patients with SLE and CAD. It remains unclear whether these findings identify subsets of patients at increased risk of cardiovascular events, and whether such results are clinically helpful in patient management.
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