Severe aortic stenosis and mitral regurgitation in a woman with systemic lupus erythematosus

Moyssakis, Ioannis; Tzioufas, Athanasios G.; Triposkiadis, Filippos; Strateges, N.; Kyriakidis, Michael

doi:10.1002/clc.4960250412

Cited by 4 publications

(5 citation statements)

References 12 publications

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“…In all 5 cases, a valvular replacement was performed and a bivalve mechanical prosthesis was implanted. Reports of valvular surgery in SLE patients are scarce: only about 50 cases have been reported, mostly individual case reports (16–46). Our series of 5 patients is the same size as the largest previously published (41).…”

Section: Discussionmentioning

confidence: 99%

Severe valvular regurgitation and antiphospholipid antibodies in systemic lupus erythematosus: A prospective, long-term, followup study

Pérez‐Villa¹,

Font²,

Azqueta³

et al. 2005

Arthritis Rheum

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Objective. To assess whether the presence of antiphospholipid antibodies is related to the incidence and progression of severe valvular dysfunction and the need for valve replacement in patients with systemic lupus erythematosus (SLE). Methods. In this prospective, long-term followup study, the initial echocardiographic findings in a cohort of 61 consecutive SLE patients were compared with those of 40 matched controls. All patients were serially evaluated for 14 ؎ 3 years and had a followup echocardiogram 8 ؎ 3 years after the initial evaluation. Serial determinations of anticardiolipin antibodies and lupus anticoagulant were performed in all cases. Results. The number of SLE patients with valvular abnormalities increased from 39% to 73% between the initial and the followup echocardiography, but only 7 patients (12%) developed severe valvular regurgitation. Severe valvular regurgitation was significantly associated with the presence of high levels of IgG anticardiolipin antibodies (P ‫؍‬ 0.001). The combined incidence of stroke, peripheral embolism, need for valve surgery, and death was 86% in patients with severe valvular regurgitation, compared with 25% in those without (P ‫؍‬ 0.003). Conclusion. In SLE patients, the presence of high levels of IgG anticardiolipin antibodies is associated with the development of severe valvular regurgitation and with a high incidence of thromboembolic events and the need for valvular surgery.

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Section: Discussionmentioning

confidence: 99%

Severe valvular regurgitation and antiphospholipid antibodies in systemic lupus erythematosus: A prospective, long-term, followup study

Pérez‐Villa¹,

Font²,

Azqueta³

et al. 2005

Arthritis Rheum

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“…However, a subset of patients has been reported to develop significant valvular insufficiency or stenosis, affecting one or more valves, that can lead to symptomatic heart failure and require surgical intervention [19,20]. One compelling case involved a young woman with SLE and Raynaud's, who developed severe double valve disease involving the aortic and mitral valves after being lost to follow-up, and unfortunately expired from the severity of her disease while awaiting valve replacement [21]. Rarely, Libman-Sacks lesions have been known to affect prosthetic valves enough to interfere with function [22].…”

Section: Valvular Insufficiencymentioning

confidence: 97%

Revisiting Libman–Sacks Endocarditis: A Historical Review and Update

Lee

Naguwa

Cheema

et al. 2008

Clinic Rev Allerg Immunol

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Libman-Sacks (LS) endocarditis was first described by Libman and Sacks in 1924, and is characterized by sterile, verrucous valvular lesions with a predisposition for the mitral and aortic valves. It is now regarded as both a cardiac manifestation of systemic lupus erythematosus and, in recent years, of the antiphospholipid syndrome (APS). Though typically mild and asymptomatic, LS endocarditis can lead to significant complications, including severe valvular insufficiency requiring surgery, infective endocarditis, and thromboembolic events, such as stroke and transient ischemic events. Improvements in imaging modalities, particularly in echocardiography, have allowed better estimation of the prevalence of the disease, but further investigation is still needed into its pathogenesis, treatment, and association with APS.

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“…The pathogenic mechanism of aortic valve pathology is poorly understood. Although it was linked to antiphospholipid syndrome [34], severe aortic insufficiency was reported without aPLs [11, 35].…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac diseases in lupus may involve the endocardium, myocardium, and pericardium and may be responsible for fatal outcome [11, 12]. Some cardiovascular abnormalities are seen with positive anti Ro/SS-A, anti La/SS-B, anti-cardiolipin (aCL), and anti-double-stranded DNA (anti-dsDNA) [12–14].…”

Section: Introductionmentioning

confidence: 99%

Cardiac Manifestations in Systemic Lupus Erythematosus: Clinical Correlates of Subclinical Echocardiographic Features

Mohamed

Hammam

Zohri

et al. 2019

BioMed Research International

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Objectives This study aims to correlate subclinical echocardiographic features with the clinical, laboratory, and therapeutic profiles of the patients to characterize risks for systemic lupus erythematosus (SLE) cardiac diseases. Methods The study included 59 SLE patients. Demographic data, disease characteristics, and current therapies were recorded, and the anthropometric measurements and routine laboratory tests were performed. The disease activity by the SLE Disease Activity Index-2K (SLEDAI2K) and the presence of metabolic syndrome (MetS) were assessed. Two-dimensional echocardiography was performed. Results The mean age of the patients was 31.3 ± 10.5 years, and the disease duration was 5.18 ± 4.1 years. 86.4% of the patients were females. Cardiac presentations by echocardiography were mainly mitral regurgitation (33.9%), tricuspid regurgitation (32.2%), mitral thickening (18.6%), aortic thickening (13.6%), pericardial effusion (13.6%), and pulmonary hypertension (8.5%) in order of frequency. The frequency of different echocardiographic findings with respect to other clinical phenotypes showed peaks with renal disease, MetS, and leukopenia. Components of MetS (triglycerides, high systolic blood pressure) and avascular necrosis were significant predictors for pericardial diseases (OR=1.011 CI 95% 1-1.022, p=0.046, OR=1.157 CI 95% 1.025-1.307, p=0.018, and OR=74.78 CI 95% 2.52-2215.76, p=0.013, respectively), and it is likely that hydroxychloroquine was protective against them. Age of the patients was a significant predictor for tricuspid regurgitation (OR=1.063 CI 95% 1.004-1.126, p=0.036). Mucosal ulcers were negative predictors for mitral thickening and regurgitation (OR=0.2 CI 95% 0.059-0.673, p=0.009). The use of corticosteroids appeared to protect against a number of valve lesions especially tricuspid regurgitation (OR=0.299 CI 95% 0.088-1.019, p=0.054). Conclusion This study highlighted different echocardiographic features and identified clinical predictors of different cardiac pathologies aiming to determine patients at risk and improve the prognosis of SLE cardiac diseases.

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Severe aortic stenosis and mitral regurgitation in a woman with systemic lupus erythematosus

Cited by 4 publications

References 12 publications

Severe valvular regurgitation and antiphospholipid antibodies in systemic lupus erythematosus: A prospective, long-term, followup study

Severe valvular regurgitation and antiphospholipid antibodies in systemic lupus erythematosus: A prospective, long-term, followup study

Revisiting Libman–Sacks Endocarditis: A Historical Review and Update

Cardiac Manifestations in Systemic Lupus Erythematosus: Clinical Correlates of Subclinical Echocardiographic Features

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