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Libman-Sacks endocarditis and associated cerebrovascular disease: The role of medical therapy

Carlos A Roldan1, Wilmer L Sibbitt1, Ernest R Greene1

  • 1Department of Medicine, Divisions of Cardiology and Rheumatology, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America.

Plos One
|February 16, 2021
PubMed

Insights

Conventional anti-inflammatory and anti-thrombotic therapy effectively treated Libman-Sacks endocarditis (LSE) and associated cerebrovascular disease (CVD) in systemic lupus erythematosus (SLE) patients. This medical approach improved valve function and neurological outcomes, potentially avoiding high-risk surgery.

Area of Science:

  • Rheumatology
  • Cardiology
  • Neurology

Background:

  • Libman-Sacks endocarditis (LSE) in systemic lupus erythematosus (SLE) often leads to embolic cerebrovascular disease (CVD) or valve dysfunction.
  • High-risk valve surgery is frequently considered for these complications.
  • The efficacy of medical therapy alone for LSE and associated acute CVD is not well-defined.

Purpose of the Study:

  • To evaluate the effectiveness of conventional anti-inflammatory and anti-thrombotic therapy for LSE and associated acute CVD in SLE patients.
  • To assess the impact of medical therapy on valve integrity and neurological function.

Main Methods:

  • A cross-sectional and longitudinal study involving 17 SLE patients with LSE and acute CVD.
  • Diagnosis confirmed by transesophageal echocardiography (TEE).
  • Patients received conventional anti-inflammatory and anti-thrombotic therapy for a median of 6 months, followed by comprehensive reassessment.

Main Results:

  • Significant improvements were observed in valve vegetations (number, diameter, area) and reduced valve regurgitation.
  • 76% of patients showed resolution or improvement in LSE or valve regurgitation.
  • Marked improvements in cerebromicroembolism, cerebral perfusion, ischemic brain lesions, and neurocognitive dysfunction were noted.

Conclusions:

  • Combined anti-inflammatory and antithrombotic therapy appears effective for treating LSE and associated CVD in SLE patients.
  • This medical management strategy may potentially eliminate the need for high-risk valve surgery.
Abstract

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