Abstract 19026: Libman-sacks Endocarditis: Can It Be Clinically Predicted?

Abstract

Background: Libman-Sacks endocarditis, characterized by Libman-Sacks vegetations (LSV), is common in patients with systemic lupus erythematosus (SLE) and is a strong predictor of stroke and transient ischemic attacks (TIA), cognitive dysfunction, and increased mortality. Accurate detection of LSV may lead to early therapy and prevention of development or progression of embolic cerebrovascular disease. TEE is accurate for detecting LSV, but is semi-invasive. Thus, there is a need for identifying clinical variables with a high predictive value for LSV on TEE. Methods: 76 SLE patients (69 women, 38 ± 12 years old) and 26 age-and sex-matched healthy controls underwent TEE and assessment of demographics, atherogenic risk factors, and parameters of inflammation, platelet activity, coagulation, and fibrinolysis. Patients were also assessed for SLE duration, activity, injury, therapy, and autoantibodies including antiphospholipid antibodies. Multivariate regression and optimal receiver operator curve by Neyman-Pearson lemma were used to determine the best clinical predictors of LSV on TEE. Results: 39 (51%) SLE patients vs 2 (8%) controls had LSV on TEE (p<0.001). In all 76 patients, acute stroke/TIA (OR 50.6, 95% CI = 6.8 - 374, p <0.001) and SLE duration (OR = 1.18, 95% CI = 1.05 - 1.32, p = 0.004) were the predictors of LSV. In 53 patients without acute stroke/TIA, SLE duration (OR = 1.16, CI =1.03 - 1.31, p = 0.01) and age (OR = 1.06, CI = 1.0 - 1.12, p = 0.05) were the predictors of LSV. A recruitment rule of performing TEE in SLE patients with acute stroke/TIA and in those without stroke/TIA if they have a disease duration of ≥12 years or a disease duration ≥5 years and age ≥32 provide high sensitivity (85%), specificity (81%), and positive (83%) and negative (83%) predictive values for LSV on TEE ( Figure 1 ). Conclusion: In SLE patients, acute stroke/TIA, or SLE duration ≥12 years, or SLE duration ≥5 years and age ≥32 provide a high diagnostic yield for detecting LSV on TEE.