Patients with systemic lupus erythematosus (SLE) should undergo regular screening with echocardiography after diagnosis, with particular focus on those patients with high SLE disease activity, according to research published in Autoimmunity Reviews.
In a cross-sectional study, Guillermo Ruiz-Irastorza, MD, PhD, of the autoimmune diseases research unit at the BioCruces Health Research Institute, Hospital Universitario Cruces, Spain, and colleagues set out to analyze the prevalence, severity, and clinical and immunological predictors of valvular heart disease (VHD) in patients with SLE.
Valvular lesions—defined as thickening, regurgitation, stenosis, and/or vegetations on either the mitral and aortic valves by the researchers—were classified into 1 of 2 groups: valvular thickening and valvular dysfunction.
The study group included 211 patients (88% women, mean age 33±15 years at SLE diagnosis, 44±13 years at time of study), for whom various clinical and immunological variables were collected. Mean disease duration for all patients was 10.7±8 years.
High Yield Data Summary
- Independent predictors of valvular thickening in SLE were age at the time of echocardiogram, lymphopenia, thrombocytopenia, and anti-Smith positivity
The researchers found significant valvular lesions in 25% of patients (n=53); 17% had valvular thickening only (n=35), 2% had valvular dysfunction only (n=4), and 6.6% had both (n=14).
Patients’ mitral and aortic valves were similarly affected (40 and 37 patients, respectively) with 11% of patients having both valves involved (n=28 and 29 cases, respectively); moderate-to-severe regurgitation was two times as frequent in the mitral valve than the aortic valve (12 cases vs 6 cases, respectively).
Eventually, 3 patients required valve surgery, 1 of whom had mitral regurgitation.
Independent predictors of valvular thickening were age at the time of echocardiogram (odds ratio [OR]: 1.05, 95% confidence interval [CI] 1.02.1.7), lymphopenia (OR: 3.6, 95% CI 1.4-9.5), thrombocytopenia (odds ratio [OR]: 2.65, 95% CI: 1.66-14.86), and presence of anti-Smith antibodies (OR: 3.28, 95% CI 1.44-7.33).
Independent predictors of valvular dysfunction were age at the time of echocardiogram (OR: 1.045, 95% CI 1.009-1.083), thrombocytopenia (OR: 5, 95% CI 1.66-14.86), hypertension (OR: 6.2, 95% CI: 2.1-18.4), and antiphospholipid (aPL) antibody positivity (OR: 6.2, 95% CI 2.1-18.4).
Summary and Clinical Applicability
“In this study, we found a 1 in 4 prevalence of significant valvulopathy in patients with SLE,” noted Dr Ruiz-Irastorza and colleagues. “In previous studies, the prevalence of VHD has ranged between 12% and 73%; the different criteria to define valvular lesions and the different diagnostic methods may account for the large variability in the results.”
The researchers confirm a relatively high prevalence of significant VHD among patients with SLE and a confirmed association between VHD and aPL positivity.
Limitations and Disclosures
- Cross-sectional study design, which did not evaluate the evolution of valvular heart disease over time
- Serial quantification of lupus activity was not available, limited the interpretation of the association of both thrombocytopenia and lymphopenia with VHD
Vivero F, Gonzalez-Echavarri C, Ruiz B, Maderuelo I, Ruiz-Irastorza G. Prevalence and predictors of valvular heart disease in patients with systemic lupus erythematosus. Autoimmun Rev. 2016 Sep 15 doi: 10.1016/j.autrev.2016.09.007 [Epub ahead of print]