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Prevalence, morphologic types, and evolution of cardiac valvular disease in systemic lupus erythematosus
E Galve1, J Candell-Riera, C Pigrau
1Servicio de Cardiología, Hospital General Vall d'Hebron, Barcelona, Spain.
Insights
Systemic lupus erythematosus (SLE) patients frequently develop clinically important valvular disease, sometimes requiring surgery. Echocardiography helps identify specific lesions prone to hemodynamic deterioration.
Area of Science:
- Cardiology
- Rheumatology
- Internal Medicine
Background:
- Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect multiple organs, including the heart valves.
- Valvular involvement in SLE, such as Libman-Sacks endocarditis, can range from mild to severe, potentially leading to significant morbidity.
Purpose of the Study:
- To prospectively evaluate the prevalence and characteristics of valvular heart disease in patients with SLE using echocardiography.
- To identify specific echocardiographic findings associated with clinically important valvular disease and hemodynamic deterioration in SLE patients.
Main Methods:
- Prospective echocardiographic follow-up over approximately five years in 74 patients with SLE.
- Classification of patients into four groups based on valvular involvement: Libman-Sacks endocarditis, rigid/thickened valves with dysfunction, miscellaneous involvement without dysfunction, and no valvular disease.
- Comparison of demographic and clinical characteristics between patient groups.
Main Results:
- Overall prevalence of clinically important valvular disease (Libman-Sacks endocarditis or thickened/dysfunctional valves) was 18% in SLE patients.
- Patients with Libman-Sacks endocarditis were younger, had shorter lupus duration, and received lower cumulative steroid doses compared to those with thickened/dysfunctional valves.
- During follow-up, 1 patient with Libman-Sacks endocarditis and 5 with thickened/dysfunctional valves required valve surgery. Echocardiography identified valvular thickening and dysfunction as lesions prone to hemodynamic deterioration.
Conclusions:
- Clinically important valvular involvement is a relatively frequent complication of SLE, sometimes necessitating surgical intervention.
- Echocardiography is crucial for detecting specific valvular lesions in SLE, particularly those beyond Libman-Sacks endocarditis, that carry a risk of hemodynamic compromise.
Abstract:
We performed echocardiography prospectively 4.9 +/- 0.7 years apart (mean +/- SD), in 74 patients with systemic lupus erythematosus. On the basis of the first study, the patients were distributed in four groups according to the type of valvular involvement: 7 patients had vegetations (Libman-Sacks endocarditis; group 1); 6 patients had rigid and thickened valves with stenosis, regurgitation, or both (group 2); 5 patients had miscellaneous forms of valvular involvement without valvular dysfunction (group 3), as did the 60 controls; and 56 patients had no valvular disease (group 4). The overall prevalence of clinically important valvular disease (groups 1 and 2) was 18 percent. Patients in group 1 were younger than those in group 2 (33.5 +/- 16.7 vs. 47.8 +/- 17.6 years; P less than 0.05), had a shorter mean duration of lupus (4.8 +/- 2.2 vs. 10.7 +/- 6.4 years; P less than 0.001), and had received a smaller cumulative dose of steroids (21.5 +/- 13.1 vs. 79.5 +/- 63.4 g of methylprednisolone or its equivalent; P less than 0.05). During the five-year follow-up, one patient in group 1 and five in group 2 required valve surgery, no patient in group 3 had valvular dysfunction, and five patients in group 4 had mild valvular lesions. We conclude that clinically important valvular involvement in systemic lupus is relatively frequent and sometimes requires surgery. Echocardiography can identify a subset of lesions (valvular thickening and dysfunction), other than verrucous (Libman-Sacks) endocarditis, that are prone to hemodynamic deterioration.