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Published on: December 6, 2016
Lambl's Excrescences: Association with Cerebrovascular Disease and Pathogenesis
Carlos A Roldan1, Oleksandr Schevchuck, Kirsten Tolstrup
1Department of Medicine, Divisions of Cardiology and Rheumatology, University of New Mexico School of Medicine, Albuquerque, N.M., USA.
Insights
Lambl's excrescences (LEx) are common in healthy individuals and do not cause cerebrovascular disease (CVD). These valve structures do not require therapy and are not linked to aging or other risk factors.
Area of Science:
- Cardiology
- Neurology
- Rheumatology
Background:
- Lambl's excrescences (LEx) are thin, mobile valve structures detected by transesophageal echocardiography (TEE).
- The association between LEx and cerebrovascular disease (CVD) remains unclear, leading to unproven treatments.
- LEx association with aging, inflammation, or thrombogenesis is not well-established.
Purpose of the Study:
- To investigate the prevalence of LEx in patients with systemic lupus erythematosus (SLE).
- To determine the association between LEx and cerebrovascular disease (CVD) in SLE patients.
- To explore the relationship between LEx and various risk factors for CVD.
Main Methods:
- Seventy-seven SLE patients and 26 healthy controls underwent comprehensive cardiovascular and neurological assessments.
- Evaluations included transcranial Doppler, brain MRI, TEE, carotid duplex, and laboratory tests for atherogenesis, inflammation, and coagulation.
- Patients were followed for a median of 57 months to assess stroke or transient ischemic attack (TIA) incidence.
Main Results:
- LEx prevalence was similar in controls (46%) and SLE patients (39-43%), irrespective of CVD status.
- No significant association was found between LEx and CVD, including stroke, TIA, or cerebral infarcts (p ≥ 0.72).
- LEx were not linked to aging, atherogenic factors, atherosclerosis, inflammation, or thrombogenesis.
Conclusions:
- LEx are prevalent in healthy individuals and SLE patients and are not associated with CVD.
- Findings suggest LEx are not pathological valve structures, may not be cardioembolic sources, and likely do not require therapeutic intervention.
- LEx are not associated with common risk factors for cardiovascular or cerebrovascular events.
Background:
Lambl's excrescences (LEx) are detected by transesophageal echocardiography (TEE) and are characterized as thin, elongated, and hypermobile structures located at the leaflets' coaptation point of the heart valves. The association of LEx with cerebrovascular disease (CVD) is still undefined and yet patients with LEx and suspected CVD receive unproven effective antiplatelet or anticoagulant therapy or even undergo valve surgery. Also, the association of LEx with aging and atherogenic, inflammatory, or thrombogenic parameters has not been reported.
Methods:
Seventy-seven patients with systemic lupus erythematosus (SLE) (71 women, age 37 ± 12 years) and 26 age- and sex-matched healthy controls (22 women, age 34 ± 11 years) prospectively underwent routine history and physical exam, transcranial Doppler, brain MRI, TEE, carotid duplex, and clinical and laboratory evaluations of atherogenesis, inflammation, platelet activity, coagulation, and fibrinolysis. Subjects without stroke/TIA on enrollment (with and without LEx) had a median follow-up of 57 months.
Results:
On enrollment, 33 (43%) of 77 patients had CVD manifested as acute stroke/TIA (23 patients), cerebromicroembolism by transcranial Doppler (17 patients), or cerebral infarcts by MRI (14 patients). Mitral or aortic valve LEx were equally frequent in healthy controls (46%) as in patients with and without any CVD (39 and 43%), stroke/TIA (35 and 43%), cerebromicroembolism (41 and 42%), or cerebral infarcts (36 and 43%) (all p ≥ 0.72). Also, other mechanisms for CVD other than LEx such as Libman-Sacks vegetations, patent foramen ovale or interatrial septal aneurysm, aortic or carotid atherosclerosis, or thrombogenesis were found in ≥94% of patients with CVD. In addition, 36 subjects with and 44 without LEx had similar low incidence of stroke/TIA (1 (1.3%) and 2 (2.5%), respectively, p = 1.0) during follow-up. Finally, LEx were not associated with aging, atherogenic risk factors, atherosclerosis, inflammation, or thrombogenesis.
Conclusions:
In this study, LEx are similarly prevalent in healthy controls and SLE patients, are not associated with CVD, and are not associated with pathogenic risk factors. Therefore, the study findings suggest that LEx may not be cardioembolic substrates, may not represent pathologic valve structures, and may not require therapy.
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