FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 319:817-823 September 29, 1988 Number 13 Next

	Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

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.

Source Information

Servicio de Cardiologia, Hospital General Vall d'Hebron, Barcelona, Spain.

This article has been cited by other articles:

• Dandekar, U. P., Watkin, R., Chandra, N., Santo, K. C., Bhudia, S., Pitt, M., Rooney, S. J. (2009). Aortic valve replacement for Libman-Sacks endocarditis.. Ann. Thorac. Surg. 88: 669-671 [Abstract] [Full Text]  
• Enriquez-Sarano, M., Nkomo, V. T., Michelena, H. (2008). Principles and Practice of Echocardiography in Cardiac Surgery. Card Surg Adult 3: 315-348 [Full Text]  
• Roman, M. J., Salmon, J. E. (2007). Cardiovascular Manifestations of Rheumatologic Diseases. Circulation 116: 2346-2355 [Full Text]  
• Lockhart, P. B., Loven, B., Brennan, M. T., Fox, P. C. (2007). The evidence base for the efficacy of antibiotic prophylaxis in dental practice. Journal of the American Dental Association 138: 458-474 [Abstract] [Full Text]  
• Taguchi, S., Hashimoto, K., Sakamoto, Y., Okuyama, H., Ishii, S. (2006). A case of mitral valve plasty for Libman-Sacks endocarditis mimicking a cardiac tumor. J. Thorac. Cardiovasc. Surg. 132: 1465-1467 [Full Text]  
• Erdogan, D., Goren, M. T., Diz-Kucukkaya, R., Inanc, M. (2005). Assessment of Cardiac Structure and Left Atrial Appendage Functions in Primary Antiphospholipid Syndrome: A Transesophageal Echocardiographic Study. Stroke 36: 592-596 [Abstract] [Full Text]  
• Evangelopoulos, M E, Alevizaki, M, Toumanidis, S, Sotou, D, Evangelopoulos, C D, Koutras, D A, Stamatelopoulos, S F, Mavrikakis, M (2003). Mitral valve prolapse in systemic lupus erythematosus patients: clinical and immunological aspects. Lupus 12: 308-311 [Abstract]  
• Jensen-Urstad, K, Svenungsson, E, de Faire, U, Silveira, A, Witztum, J L, Hamsten, A, Frostegard, J (2002). Cardiac valvular abnormalities are frequent in systemic lupus erythematosus patients with manifest arterial disease. Lupus 11: 744-752 [Abstract]  
• Daugas, E., Nochy, D., Huong, D. L. T., Duhaut, P., Beaufils, H., Caudwell, V., Bariety, J., Piette, J.-C., Hill, G. (2002). Antiphospholipid Syndrome Nephropathy in Systemic Lupus Erythematosus. J. Am. Soc. Nephrol. 13: 42-52 [Abstract] [Full Text]  
• Ilarraza, H, Marquez, M F, Alcocer, A, Banales, J L, Nava, A H, Reyes, P A (2001). Anticardiolipin antibodies are not associated with rheumatic heart disease. Lupus 10: 873-875 [Abstract]  
• Espinola-Zavaleta, N, Amigo, M C, Vargas-Barron, J, Keirns, C, Cardenas, A R., Vidal, M, Roldan, J (2001). Two and three-dimensional echocardiography in primary antiphospholipid syndrome: misdiagnosis as rheumatic valve disease. Lupus 10: 511-513 [Abstract]  
• Font, J., Ramos-Casals, M., Cervera, R., Garcia-Carrasco, M., Torras, A., Siso, A., Darnell, A., Ingelmo, M. (2001). Cardiovascular risk factors and the long-term outcome of lupus nephritis. QJM 94: 19-26 [Abstract] [Full Text]  
• Tektonidou, M G, Ioannidis, J P A, Moyssakis, I, Boki, K A, Vassiliou, V, Vlachoyiannopoulos, P G, Kyriakidis, M K, Moutsopoulos, H M (2001). Right ventricular diastolic dysfunction in patients with anticardiolipin antibodies and antiphospholipid syndrome. Ann Rheum Dis 60: 43-48 [Abstract] [Full Text]  
• Bijl, M, Brouwer, J, Kallenberg, G G. (2000). Grand Rounds from International Lupus Centres Cardiac abnormalities in SLE: pancarditis. Lupus 9: 236-240 [Abstract]  
• Afek, A, Shoenfeld, Y, Manor, R, Goldberg, I, Ziporen, L, George, J, Polak-Charcon, S, Amigo, M C, Garcia-Torres, R, Segal, R, Kopolovic, J (1999). Increased endothelial cell expression of a3{beta}1 integrin in cardiac valvulopathy in the primary (Hughes) and secondary antiphospholipid syndrome. Lupus 8: 502-507 [Abstract]  
• Kalke, S, Balakrishanan, C, Mangat, G, Mittal, G, Kumar, N, Joshi, V R (1998). Echocardiography in systemic lupus erythematosus. Lupus 7: 540-544 [Abstract]  
• Roldan, C. A., Shively, B. K., Crawford, M. H. (1996). An Echocardiographic Study of Valvular Heart Disease Associated with Systemic Lupus Erythematosus. NEJM 335: 1424-1430 [Abstract] [Full Text]  
• Ziporen, L., Goldberg, I., Arad, M., Hojnik, M., Ordi-Ros, J., Afek, A., Blank, M., Sandbank, Y., Vilardell-Tarres, M., de Torres, I., Weinberger, A., Asherson, R., Kopolovic, Y., Shoenfeld, Y. (1996). Libman-Sacks endocarditis in the antiphospholipid syndrome: immunopathologic findings in deformed heart valves. Lupus 5: 196-205 [Abstract]  
• Hojnik, M., George, J., Ziporen, L., Shoenfeld, Y. (1996). Heart Valve Involvement (Libman-Sacks Endocarditis) in the Antiphospholipid Syndrome. Circulation 93: 1579-1587 [Abstract] [Full Text]  
• Chauvaud, S. M., Kalangos, A., Berrebi, A. J., Gaer, J. A. R., Acar, C., Carpentier, A. F. (1995). Systemic Lupus Erythematosus Valvulitis: Mitral Valve Replacement With a Homograft. Ann. Thorac. Surg. 60: 1803-1805 [Abstract] [Full Text]  
• Morelli, S., Perrone, C., Valesini, G. (1995). Tricuspid Valve Steno-Insufficiency in Systemic Lupus Erythematosus. Lupus 4: 318-320 [Abstract]  
• Abraham, S.A., Hansen, K.K. (1995). Case 11-1995- A 39-year-old man with chronic renal failure, aortic regurgitation, and a calcified mass about the aortic root. NEJM 332: 1015-1022 [Full Text]  
• Sclair, M., Nassar, H., Bar-Ziv, Y., Putterman, C. (1995). Dissecting aortic aneurysm in systemic lupus erythematosus. Lupus 4: 71-74 [Abstract]  
• Fresko, I., Yazici, H., Isci, H., Yurdakul, S. (1993). Genital Ulceration in Patients with Systemic Lupus Erythematosus. Lupus 2: 135-135  
• Galve, E., Ordi, J., Barquinero, J., Evangelista, A., Vilardell, M., Soler-Soler, J. (1992). Valvular Heart Disease in the Primary Antiphospholipid Syndrome. ANN INTERN MED 116: 293-298 [Abstract]  
• Cervera, R., Khamashta, M. A., Font, J., Reyes, P. A., Vianna, J. L., Lopez-Soto, A., Amigo, M.-C., Asherson, R. A., Azqueta, M., Pare, C., Vargas, J., Romero, A., Ingelmo, M., Hughes, G. R.V. (1991). High Prevalence of Significant Heart Valve Lesions in Patients with the 'Primary' Antiphospholipid Syndrome. Lupus 1: 43-47 [Abstract]  
• Klippel, J. H. (1990). Systemic Lupus Erythematosus: Treatment-Related Complications Superimposed on Chronic Disease. JAMA 263: 1812-1815 [Abstract]