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NEW YORK (Reuters Health) Jul 27
- In patients with systemic lupus erythematosus (SLE), valvular
heart disease appears to be a source of emboli that cause ischemic
brain injury, results of a study show.
Cerebrovascular disease and valvular heart disease are both common
in patients with SLE, Dr. Carlos A. Roldan and his associates note
in their report, published in the June 15th American Journal of
Cardiology. In order to evaluate any association between the two
disorders, they performed clinical and laboratory evaluations,
MRI of the brain, and transesophageal echocardiography in 37 patients
with SLE.
Nineteen (51%) had cerebrovascular disease (stroke, transient
ischemic attack or cerebral infarcts associated with nonfocal neurologic
deficits). Twenty-five (68%) had valve vegetations, moderate or
severe valve thickening, or moderate to severe regurgitation.
Valvular heart disease was present in 16 (84%) of those with cerebrovascular
disease and 9 (50%) of those without cerebrovascular disease (p
= 0.04).
Multivariate analysis showed that mitral regurgitation and lupus
anticoagulant antibody were the only independent predictors of
cerebral infarcts, while mitral valve thickening was the only predictor
of stroke or TIA.
"We know that valve vegetations and valve thickening are substrates
for formation of microthrombi, even in patients with no underlying
hypercoagulable state," Dr. Roldan said in an interview with Reuters
Health. So regardless of whether they have hypercoagulability,
he added, "lupus patients with valve disease should be considered
for antiplatelet therapy, such as aspirin, to decrease the rate
of microemboli to the brain."
Dr. Roldan pointed out that lupus patients have such a large constellation
of symptoms and a high incidence of physiological heart murmurs
that valvular heart disease may be overlooked.
"Clinicians may need to be more careful about their patient interviews
as well as cardiovascular physical exams in order to find a clinical
reason to order echocardiography," he added, but without a cost-effectiveness
analysis, he is not yet ready to propose echocardiography as a
routine screening tool in patients with SLE.
Am J Cardiol 2005;95:1441-1447.
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