A Meta-analysis and Systematic Review of Valvular Heart Disease in Systemic Lupus Erythematosus and Its Association With Antiphospholipid Antibodies

Abstract

Background: Valvular heart disease (VHD) is a known cardiac manifestation of systematic lupus erythematosus (SLE). This systematic review aims to pool data from studies to estimate the frequency of valvular lesions in SLE patients. It also aims to demonstrate the association between VHD in SLE and antiphospholipid antibodies positivity. Methods:We included 27 studies after identifying relevant abstracts from PubMed, Scopus, and Google Scholar from the time of inception of database to 2019. Inclusion criteria consisted of English-language casecontrol and cohort studies. Three reviewers independently performed study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale for assessing risk for bias.Results: For VHD in SLE patients, the most commonly involved valve was the mitral valve, with 19.7% lesions being mitral regurgitation. In terms of morphological lesions, valve thickening (11.06%) and vegetations (11.76%) were among the most prevalent. Other commonly encountered lesions were mitral valve prolapse and tricuspid regurgitation in 9.25% and 10.86% of patients, respectively. A meta-analysis of 21 studies with 2163 SLE patients, of which 23.3% had valvular lesions, showed a significant association of anticardiolipin antibodies positivity with VHD (relative risk, 1.55; confidence interval, 1.10-2.18).Conclusions: Systemic lupus erythematosus is associated with VHD, and it should be considered a clinical manifestation of SLE in the absence of other valvular pathologies. There is a clear association between VHD in SLE and immunoglobulin G anticardiolipin antibodies positivity. This association suggests that this subgroup of SLE patients might benefit from a screening echocardiogram.

Inflammatory and thrombotic valvulopathies in autoimmune disease

“…A meta-analysis of 1656 patients with SLE concluded that valve disease and vegetations were significantly more prevalent in patients with aPL, ORs of 3.13 (95% CI 2.31 to 4.24) and 3.51 (95% CI 1.93 to 6.38), respectively 15. Another meta-analysis published 10 years later came to a similar conclusion that anti-cardiolipin aPL was associated with valvular disease, although with a lower relative risk of 1.55 (95% CI 1.10 to 2.18) 16…”

Endocardial Fibroelastosis as an Independent Predictor of Atrioventricular Valve Rupture in Maternal Autoimmune Antibody Exposed Fetus: A Systematic Review with Clinicopathologic Analysis

“…Acute MR due to chordal rupture in infancy represents a distinct disease entity, compared to the chordal rupture that is frequently seen in adults due to ischemia or inflammation [ 15 , 20 ]. Valvular regurgitation and rupture in autoimmune diseases in adults are known [ 21 ]. Valvar disease due to dysfunction of the tensor apparatus is a severe complication reported in 1.6% of autoimmune antibody-exposed pregnancies with CHB and 4% of non-CHB cardiac patients [ 1 ].…”

Cardiac Magnetic Resonance in Rheumatology to Detect Cardiac Involvement Since Early and Pre-clinical Stages of the Autoimmune Diseases: A Narrative Review

“…Specific manifestations can cause HF in SLE, which has been reported with a prevalence of 1–10% in SLE ( 47 , 50 ). MI and coronary artery disease (CAD) are the leading causes of CVD in these patients ( Figure 2B ), besides being significant risk factors for the development of HF ( 50 ).…”

“…The most commonly involved was the mitral valve, with mitral regurgitation being the most common valve disease. Other lesions were mitral stenosis, tricuspid regurgitation ( Figure 2A.e.3 ), and aortic regurgitation ( 47 ). In the same study, the authors found that compared to control subjects, SLE patients had an increased risk of developing valve disease, the highest risk being valvular thickening (RR 6.99, CI 3.64–13.44) and valvular vegetations (RR 7.73, CI 3.09–19.3) ( 47 ).…”

“…Other lesions were mitral stenosis, tricuspid regurgitation ( Figure 2A.e.3 ), and aortic regurgitation ( 47 ). In the same study, the authors found that compared to control subjects, SLE patients had an increased risk of developing valve disease, the highest risk being valvular thickening (RR 6.99, CI 3.64–13.44) and valvular vegetations (RR 7.73, CI 3.09–19.3) ( 47 ). VHD has been linked to high titers of antiphospholipid antibodies (aPL) ( 48 , 49 ).…”