Sandhu VK, et al. - Previous studies have indicated that those with systemic lupus erythematosus (SLE) show a relatively high prevalence of coronary microvascular dysfunction (CMD) in the absence of obstructive coronary artery disease (CAD), so researchers examined a cohort of SLE patients first assessed for anginal chest pain (CP) for the prospective change in the prevalence of CMD and obstructive CAD. They performed a re-evaluation at 5 years of 20 female SLE subjects with CP who underwent stress cardiac magnetic resonance imaging and coronary computed tomography angiography at baseline. Of these, 17 subjects (85%) were available and re-enrolled; eleven (65%) had persistent chest pain on follow up. Myocardial perfusion was similar or worse in almost half of these patients, consistent with CMD without obstructive CAD. Compared to the more common SLE-related accelerated obstructive CAD accounting for CP and adverse outcomes, the findings offer an alternative explanation for CP in SLE subjects.