Valvular Heart Disease as a Cause of Cerebrovascular Disease in Patients With Systemic Lupus Erythematosus

• Published in: The American journal of cardiology 2005-06, Vol.95 (12), p.1441-1447
• Main Authors: Roldan, Carlos A., Gelgand, Erika A., Qualls, Clifford R., Sibbitt, Wilmer L.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aortic Valve Insufficiency - complications; Aortic Valve Insufficiency - diagnostic imaging; Aortic Valve Insufficiency - physiopathology; Biological and medical sciences; Blood vessels; Brain - pathology; Cardiology. Vascular system; Cardiovascular disease; Echocardiography, Doppler; Echocardiography, Transesophageal - methods; Endocardial and cardiac valvular diseases; Female; Heart; Humans; Lupus; Lupus Coagulation Inhibitor - blood; Lupus Coagulation Inhibitor - immunology; Lupus Erythematosus, Systemic - blood; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - diagnosis; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Mitral Valve Insufficiency - complications; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - physiopathology; Neurology; Predictive Value of Tests; Prognosis; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Severity of Illness Index; Stroke - diagnosis; Stroke - etiology; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2005.02.010

Thirty-seven patients with systemic lupus erythematosus underwent complete clinical and laboratory evaluations, including antiphospholipid antibodies and lupus anticoagulant, magnetic resonance imaging of the brain, and transesophageal echocardiography. Cerebrovascular disease manifested as stroke, transient ischemic attack, or cerebral infarcts in patients with nonfocal neurologic deficits was detected in 19 patients (51%), and significant left-sided valvular heart disease in 25 (68%). Valve vegetations, valve thickening, valve regurgitation, and lupus anticoagulant antibody occurred 2 to 3 times more often in patients with than without cerebrovascular disease (all p ≤0.04) and were the only independent predictors of cerebrovascular disease (odd ratios 5.3 to 10.6, all p ≤0.03). Thus, valvular heart disease probably exacerbated by hypercoagulability appears to be a source of embolic ischemic brain injury and cerebrovascular disease.