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Published on: May 28, 2010
An echocardiographic study of valvular heart disease associated with systemic lupus erythematosus
C A Roldan1, B K Shively, M H Crawford
1University of New Mexico Health Sciences Center and Veterans Affairs Medical Center, Albuquerque 87108, USA.
Insights
Systemic lupus erythematosus (SLE) commonly causes valvular heart disease, which often changes over time and is linked to significant illness and death. This heart valve disease in lupus patients is not related to disease activity or treatment.
Area of Science:
- Cardiology
- Rheumatology
- Systemic Lupus Erythematosus Research
Background:
- Valvular heart disease is a primary cardiac complication in systemic lupus erythematosus (SLE).
- Understanding the relationship between valvular disease and SLE clinical features is crucial.
- Assessing the progression, morbidity, and mortality associated with SLE-related valvular disease is important.
Purpose of the Study:
- To determine the association between valvular disease and other clinical features of SLE.
- To investigate the progression of valvular disease in SLE patients.
- To evaluate the morbidity and mortality linked to valvular heart disease in SLE.
Main Methods:
- Transesophageal echocardiography and rheumatologic evaluations were conducted in 69 SLE patients and 56 healthy controls.
- Patients underwent a second evaluation after a mean of 29 months, with a total follow-up of 57 months.
- Echocardiographic findings were compared between initial and follow-up assessments and between patients and controls.
Main Results:
- Valvular abnormalities were prevalent in SLE patients (61% initially, 53% at follow-up), with thickening being the most common finding.
- Abnormalities often changed, resolved, or appeared anew; mild/moderate regurgitation did not worsen, and new stenosis did not develop.
- Valvular disease in SLE patients was associated with higher rates of stroke, heart failure, and valve replacement (22% vs. 8% in controls), and mortality was often linked to valvular issues.
Conclusions:
- Valvular heart disease is a frequent and dynamic complication of SLE.
- The development and changes in valvular disease are not clearly related to SLE activity, duration, or treatment.
- SLE-related valvular heart disease significantly contributes to patient morbidity and mortality.
Background:
Valvular heart disease is the most important cardiac manifestation of systemic lupus erythematosus. We performed a study to determine the relation of valvular disease to other clinical features of lupus, whether or not the valve disease progresses, and the associated morbidity and mortality.
Methods:
We performed transesophageal echocardiography and rheumatologic evaluations in 69 patients with systemic lupus erythematosus. The echocardiographic findings were compared with those in 56 healthy volunteers. Fifty-eight patients (84 percent) had second evaluations a mean (+/-SD) period of 29 +/- 13 months later. The patients and controls were followed for 57 months.
Results:
Valvular abnormalities were common on the initial and the follow-up echocardiograms (in 61 and 53 percent of the patients, respectively). Valvular thickening was the predominant finding initially and on follow-up (in 51 and 52 percent of the patients, respectively), followed by vegetations (in 43 and 34 percent), valvular regurgitation (in 25 and 28 percent), and stenosis (in 4 and 3 percent). Valvular abnormalities frequently resolved, appeared for the first time, or persisted but changed in appearance or size between the two studies. Mild or moderate valvular regurgitation did not progress to become severe, and new stenoses did not develop. Neither the presence of valvular disease nor changes in the echocardiographic findings were temporally related to the duration, activity, or severity of lupus or to its treatment. The combined incidence of stroke, peripheral embolism, heart failure, infective endocarditis, and the need for valve replacement was 22 percent in the patients with valvular disease, but only 8 percent in those without it. A total of seven patients died during follow-up, in most cases as a result of valvular disease. Valvular abnormalities and complications were uncommon in the controls (occurring in 9 and 2 percent, respectively).
Conclusions:
Valvular heart disease is common in patients with systemic lupus erythematosus, frequently changes over time, appears to be temporally unrelated to other clinical features of lupus, and is associated with substantial morbidity and mortality.
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