Cardiac valvular disease in patients with systemic lupus erythematosus. Relationship with anticardiolipin antibodies

Abstract

We performed two-dimensional and Doppler echocardiography in 52 patients with systemic lupus erythematosus and in 34 healthy controls. In 25 patients (48.1%) echocardiographic disturbances were found (25/52 vs 2/34, p<0.001). Valvular abnormalities were detected in 18 patients (34.6%) but in only two controls (18/52 vs 2/34, p<0.01). The mitral valve was involved in 12 patients (23.1%). The most frequent finding was mild (13.5%) and moderate (9.6%) regurgitation or valvular thickening (9.6%). The aortic valve was involved in six and the tricuspid valve in three patients (11.5% and 5.8%, respectively). Only one patient had echocardiographic non-infective verrucous vegetation affecting the tricuspid valve. We did not observe significant hemodynamic valve disease. Endocardial findings were related to disease duration (p<0.05) but not to disease activity. Twenty-eight SLE patients (53.8%) had increased anticardiolipin antibodies (aCL). Patients with aCL (particularly those with IgG class) were characterized by a high incidence of echocardiographic abnormalities (p<0.001), mainly valvular (mitral or aortic) regurgitation (p<0.05). We found a relationship between anticardiolipin antibodies and disease activity (p<0.05). In conclusion, we postulate a prominent role for anticardiolipin antibodies in the pathogenesis of heart valve disease in patients with SLE.

Increased Risk for Heart Valve Disease Associated With Antiphospholipid Antibodies in Patients With Systemic Lupus Erythematosus

“…Our literature search identified 234 publications, of which 23 unique studies were included in the review 13,21,22,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] ( Figure 1). Studies were identified with the use of Embase (nϭ115), MEDLINE (nϭ97), Cochrane Library (nϭ0), and hand search (nϭ22) from August 1987 to December 2010.…”

Establishing the Diagnosis of Libman–Sacks Endocarditis in Systemic Lupus Erythematosus

“…If levels are moderate to high positive, this is more suggestive of SLE. 9 The associated link of antiphospholipids with lupus is wellknown 11,12 and helps provide an additional mechanism of injury to the cardiac valve as seen in Libman-Sacks endocarditis, possibly one of deposition of immunoglobulin and complement. 13 Studies of echocardiographic findings when compared with anticardiolipin and antiphospholipid antibody titers have shown significant correlation for more severe valve dysfunction with increasing titers.…”

“…13 Studies of echocardiographic findings when compared with anticardiolipin and antiphospholipid antibody titers have shown significant correlation for more severe valve dysfunction with increasing titers. 8,11 [var vr_print_hyperlink]Our patient's white blood cell count was normal on admission and decreased during the course of her hospitalization. Her CRP was elevated.…”

“…A previous C3 level 1 year before admission was within the normal range at 113 mg/dL. A quantitative assay of rheumatoid factor was 10 (range [10][11][12][13][14]. The erythrocyte sedimentation rate (ESR) was 106 mm/h (range 0-20 mm/h) and C-reactive protein (CRP) was elevated at 11.4 mg/dL (range <0.9 mg/dL).…”

Heart

“…Complement and immunoglobulin deposition in small vessels have also been identified by immunofluorescence, implicating a role for immune complex deposition in disease pathogenesis. Leszczynski et al [65] compared echocardiographic findings in 52 SLE patients with those of 34 healthy controls. The presence of anticardiolipin antibodies has also been associated with valvular heart disease in both SLE and non-SLE patients.…”