INCIDENCE OF VERRUCOUS VEGETATIONS IN SYSTEMIC LUPUS ERYTHEMATOSUS. THE ASSOCIATION WITH ANTIPHOSPHOLIPID ANTIBODIES

Abstract

Background: Valvular heart disease is prevalent in systemic lupus erythematosus (SLE) and is a common cause of morbidity and mortality. Valvular thickening and verrucous valvular vegetations (Libman–Sacks) are the most common lesions. The purpose of this prospective study was to analyze the incidence of Libman–Sacks vegetations in patients with SLE. Methods: Two hundred and seventeen consecutive patients (196 females, 21 males, aged 53 ± 11 years) with SLE were evaluated with M‐mode, 2D, and Doppler echocardiography. Libman–Sacks vegetations were defined as distinct localized masses of varying size and shape on the surface of the valve leaflets and exhibiting no independent motion. In 76 (35%) patients with SLE there were antiphospholipid antibodies (APL) present. Results: Thirty‐two (14.7%) patients with SLE had Libman–Sacks vegetations and in 21 (65.6%) of them there was a presence of antiphospholipid antibodies. In 22 patients the location of the masses was in the mitral, in 9 in the aortic, and in 1 in the tricuspid valve, whereas in 4 cases in BOTH valves. Valvular regurgitation was the predominant lesion in 18 mitral, 9 aortic, and 1 tricuspid, but only 2 cases had severe mitral regurgitation. Valvular stenosis was detected in 5 cases. Three patients had severe mitral stenosis and one of them died, while in the other two patients mitral stenosis was reversed with treatment of the underlying disease. The remaining two cases had severe aortic stenosis but one of them, also having severe mitral regurgitation, died suddenly. Conclusion: Our results show that Libman–Sacks vegetations are quite frequent in patients with SLE and are related to the presence of antiphospholipid antibodies. The most common lesion is valvular regurgitation and rarely valvular stenosis.