Abstract 14934: Libman-Sacks Endocarditis and Sjogren’s Syndrome: Are They Associated?

Abstract

Introduction: Libman-Sacks endocarditis (LSE) in patients with systemic lupus erythematosus (lupus) is frequently complicated with stroke or TIA, acute or chronic progressive valve dysfunction, need for high-risk valve surgery, and increased morbidity and mortality. Sjogren’s syndrome characterized by dry eyes and mouth for >3 months and positive anti-Ro/SSA or SSB antibodies is common in lupus patients, but its association with LSE is unknown Aim: To determine if Sjogren’s syndrome is associated and predictive of LSE. Methods: 76 lupus patients (71 women, 36 ± 12 years of age) and 26 age-and-sex frequency (3:1 ratio) matched controls (22 women, 34 ± 11 years of age) underwent TEE and assessment of demographics, atherogenic risk factors, and parameters of inflammation and thrombogenesis. Patients were also assessed for lupus duration, activity, injury, autoantibodies, and therapy. Libman-Sacks vegetations by TEE were defined as localized, protruding, and sessile echodensities >3 mm in diameter with well-defined borders as part of valve leaflets, annulus, or subvalvular apparatus. All studies were coded, de-identified, and interpreted by observers blinded to participants’ clinical data. Univariate and multivariate regression analyses were used to identify predictors of LSE. Results: 39 (51%) lupus patients and 2 (8%) controls had vegetations (p<0.001). Also, 39 (51%) patients had Sjogren’s syndrome and 28 (72%) of them had vegetations (p<0.001). As shown in Table 1 , age, Sjogren’s syndrome, current smoking, β-2 glycoprotein antibodies, lupus duration, acute or recent stroke/TIA, past stroke, lupus activity and damage scores, and anti-thrombotic therapy were univariate predictors of LSE (all p≤ 0.05). However, Sjogrens’ syndrome, acute or recent stroke or TIA, and duration of lupus were the only multivariate predictors of LSE (all p≤0.02). Conclusions: Sjogren’s syndrome is an independent predictor of Libman-Sacks endocarditis.