[Abnormal left ventricular endocardial structures detected by two-dimensional echocardiography in systemic lupus...

This is a report of abnormal endocardial structures on the left ventricular wall as visualized by two-dimensional echocardiography (2-D echo) in patients with systemic lupus erythematosus. Abnormal endocardial structures, arising from the left ventricular endocardium and appearing to proliferate into the cavity, were found in 11 (20%) of 54 patients. The most frequently involved site was posterobasal left ventricular wall in the parasternal long-axis view, and the posterolateral segment of the left ventricle including the anterior and posterior papillary muscles in the parasternal short-axis view. M-mode echocardiograms, simultaneously recorded with 2-D echo, revealed abnormal structures of increased intensity adjacent to the endocardium with thicknesses of 4 approximately 7 mm. Most of the abnormal endocardial structures were observed in patients in the active phase by 2-D echo, and they appeared to regress with steroid therapy. In one autopsy case, fibrous endocardial thickening suggesting healed endocarditis was present in the anterior papillary muscle as observed by 2-D echo. Their location and response to steroid therapy suggests that these abnormal echoes could represent Libman-Sacks endocarditis.