Myocardial Perfusion Imaging in Takayasu Arteritis

• Published in: Journal of rheumatology Vol. 40; no. 12; pp. 2052 - 2060
• Main Authors: COMARMOND, Cloé, DESSAULT, Odile, DEVAUX, Jean-Yves, COSTEDOAT-CHALUMEAU, Nathalie, RESCHE-RIGON, Matthieu, ISNARD, Richard, KOSKAS, Fabien, CACOUB, Patrice, SAADOUN, David
• Format: Journal Article
• Language: English
• Published: Toronto, ON Journal of Rheumatology Publishing 01-12-2013
• Subjects: Adult; Aortic Valve Insufficiency - diagnosis; Aortic Valve Insufficiency - diagnostic imaging; Aortic Valve Insufficiency - epidemiology; Biological and medical sciences; Cardiology. Vascular system; Coronary Angiography; Coronary Circulation; Coronary heart disease; Dipyridamole; Diseases of the osteoarticular system; Echocardiography; Female; Heart; Humans; Male; Medical sciences; Microcirculation; Middle Aged; Myocardial Ischemia - diagnosis; Myocardial Ischemia - diagnostic imaging; Myocardial Ischemia - epidemiology; Myocardial Perfusion Imaging - methods; Prospective Studies; Risk Factors; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Takayasu Arteritis - diagnosis; Takayasu Arteritis - diagnostic imaging; Takayasu Arteritis - epidemiology; Thallium; Tomography, Emission-Computed, Single-Photon - methods; Vasodilator Agents; Radionuclide study; TAKAYASU ARTERITIS; Rheumatology; Cardiovascular disease; Myocardial ischemia; Scintigraphy; Coronary heart disease; Myocardial disease; Vascular disease; Microcirculation; Vasculitis; Perfusion imaging; Systemic disease; Myocardium; Medical imagery; Takayashu arteritis; MICROCIRCULATION; VASCULITIS; MYOCARDIAL ISCHEMIA; SCINTIGRAPHY
• ISSN: 0315-162X; 1499-2752
• DOI: 10.3899/jrheum.130308

Myocardial perfusion defects using scintigraphy have been frequently observed in patients with Takayasu arteritis (TA) without coronary stenosis. The aim of our study was to evaluate coronary microcirculation in TA using thallium-201 (201Tl) myocardial scintigraphy and dipyridamole (DPM) as vasodilator agent.
Twenty-five consecutive patients with TA were prospectively recruited. They were asymptomatic for cardiac issues and examined using 201Tl myocardial scintigraphy at rest and after coronary artery vasodilation with intravenous DPM. Factors associated with improvement in myocardial perfusion after DPM were identified in patients with TA.
Among 25 patients with TA, 21 (84%) had 201Tl myocardial perfusion defects and 4 (16%) had normal resting myocardial perfusion. Using a 17-segments model for quantitative image analysis, DPM significantly improved resting 201Tl myocardial perfusion in 14 patients (61%) versus 9 patients without improvement (39%). We were able to examine coronary artery stenoses in 11 patients, including 10 patients with thallium perfusion defects, and significant coronary artery stenoses were present in only 2 patients (18.2%). No significant difference was found in traditional cardiovascular risk factors between TA patients with or without improvement of myocardial perfusion after DPM. The absence of improvement in myocardial perfusion after DPM tended to be closely associated with specific features and prognostic factors of TA, such as aortic regurgitation at diagnosis, renovascular hypertension, longer duration of TA disease, and male sex.
We found the significantly high prevalence of myocardial perfusion defects mostly improved after vasodilation with DPM, which may indicate the major role of microcirculatory dysfunction in myocardial ischemia in TA.