Background:Coronary microvascular dysfunction has been described in patients with autoimmune rheumatic disease (ARD). However, it is unknown whether positron emission tomography (PET)-derived myocardial flow reserve (MFR) can predict adverse events in this population.Methods:Patients with ARD without coronary artery disease who underwent dynamic rest-stress ⁸²Rubidium PET were retrospectively studied and compared with patients without ARD matched for age, sex, and comorbidities. The association between MFR and a composite end point of mortality or myocardial infarction or heart failure admission was evaluated with time to event and Cox-regression analyses.Results:In 101 patients with ARD (88% female, age: 62±10 years), when compared with matched patients without ARD (n=101), global MFR was significantly reduced (median: 1.68 [interquartile range: 1.34–2.05] versus 1.86 [interquartile range: 1.58–2.28]) and reduced MFR (<1.5) was more frequent (40% versus 22%). MFR did not differ among subtypes of ARDs. In survival analysis, patients with ARD and low MFR (MFR<1.5) had decreased event-free survival for the combined end point, when compared with patients with and without ARD and normal MFR (MFR>1.5) and when compared with patients without ARD and low MFR, after adjustment for the nonlaboratory-based Framingham risk score, rest left ventricular ejection fraction, severe coronary calcification, and the presence of medium/large perfusion defects. In Cox-regression analysis, ARD diagnosis and reduced MFR were both independent predictors of adverse events along with congestive heart failure diagnosis and presence of medium/large stress perfusion defects on PET. Further analysis with inclusion of an interaction term between ARD and impaired MFR revealed no significant interaction effects between ARD and impaired MFR.Conclusions:In our retrospective cohort analysis, patients with ARD had significantly reduced PET MFR compared with age-, sex-, and comorbidity-matched patients without ARD. Reduced PET MFR and ARD diagnosis were both independent predictors of adverse outcomes.

中文翻译：

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自身免疫性风湿病患者 82 铷正电子发射断层显像心肌血流储备受损与不良事件之间的关联

背景：已经在自身免疫性风湿病 (ARD) 患者中描述了冠状动脉微血管功能障碍。然而，尚不清楚正电子发射断层扫描 (PET) 衍生的心肌血流储备 (MFR) 是否可以预测该人群的不良事件。方法：接受动态静息应激的 ARD 患者无冠状动脉疾病⁸²对铷 PET 进行了回顾性研究，并与年龄、性别和合并症相匹配的非 ARD 患者进行了比较。通过事件发生时间和 Cox 回归分析评估 MFR 与死亡率或心肌梗死或心力衰竭入院的复合终点之间的关联。结果：在 101 名 ARD 患者中（88% 为女性，年龄：62±10 岁），与无 ARD 的匹配患者（n=101）相比，总体 MFR 显着降低（中位数：1.68 [四分位距：1.34-2.05] 对比 1.86 [四分位距：1.58-2.28]）并且 MFR 降低（<1.5）更多频繁（40% 对 22%）。MFR 在 ARD 亚型之间没有差异。在生存分析中，与伴有和不伴有 ARD 且 MFR 正常（MFR>1. 5) 与没有 ARD 和低 MFR 的患者相比，在调整了基于非实验室的 Framingham 风险评分、静息左心室射血分数、严重的冠状动脉钙化和中/大灌注缺损的存在后。在 Cox 回归分析中，ARD 诊断和 MFR 降低都是不良事件以及充血性心力衰竭诊断和 PET 上存在中/大应力灌注缺陷的独立预测因素。进一步分析包括 ARD 和 MFR 受损之间的交互项，显示 ARD 和 MFR 受损之间没有显着的交互作用。结论：在我们的回顾性队列分析中，与年龄、性别和合并症相比，ARD 患者的 PET MFR 显着降低-匹配的无急性呼吸道疾病患者。