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Left-sided heart valve abnormalities and risk of ischemic cerebrovascular accidents in patients with systemic lupus erythematosus

Dipartimento di Medicina Interna, Policlinico Umberto I, University of Rome ‘La Sapienza’, Rome, Italy, sergio.morelli{at}uniroma1.it

M L Bernardo

Dipartimento di Medicina Interna, Policlinico Umberto I, University of Rome ‘La Sapienza’, Rome, Italy

F Viganego

Dipartimento di Medicina Interna, Policlinico Umberto I, University of Rome ‘La Sapienza’, Rome, Italy

A Sgreccia

Dipartimento di Medicina Interna, Policlinico Umberto I, University of Rome ‘La Sapienza’, Rome, Italy

P De Marzio

Dipartimento di Medicina Interna, Policlinico Umberto I, University of Rome ‘La Sapienza’, Rome, Italy

F Conti

Cattedra di Reumatologia, Dipartimento di Clinica e Terapia Medica Applicata, Policlinico Umberto I, University of Rome ‘La Sapienza’, Rome, Italy

R Priori

Cattedra di Reumatologia, Dipartimento di Clinica e Terapia Medica Applicata, Policlinico Umberto I, University of Rome ‘La Sapienza’, Rome, Italy

G Valesini

Cattedra di Reumatologia, Dipartimento di Clinica e Terapia Medica Applicata, Policlinico Umberto I, University of Rome ‘La Sapienza’, Rome, Italy

The aim of the study was to assess the relationship between ischemic cerebrovascular accidents (ICVAs), that is, transient ischemic attack (TIA) or stroke, and left-sided heart valve abnormalities (LHVAs) in patients with systemic lupus erythematosus (SLE). In total, 71 consecutive SLE patients were studied.At baseline, history, clinical and laboratoryevaluations, as well as trans-thoracic echocardiography (TTE) were performed. From the original population, so patients were followed up for a mean time of 5.80 + 1.53 years. After a mean period of 5.39 + 1.42 years; 40 patients underwent a repeat TTE.

Previous ICVA history was present at baseline in 16 patients (22.5%). Of these, 13 (81.2%) had evidence of LHVAs on TTE. Previous ICVAs were significantly associated to diagnosis of secondary anti-phospholipid syndrome (SAPS), positivity for anti-cardiolipin antibodies (aCl), and LHVAs. Multivariate analysis confirmed the correlation between previous ICVAs and LHVAs. LHVAs were not more commonly observed in patients with SAPS compared to patients without SAPS. At the end of follow-up, irrespective of any differences in antithrombotic treatment, ICVAs had occurred in 13 patients.During follow-up, ICVAs had recurredin seven patients, while a first eventTIA occurredin one patient. Multivariate analysis confirmed the relationship between ICVAs and LHVAs, and a trend towards a positive correlation of the former with SAPS. This study demonstratesthat LHVAs represent a compelling risk factor for the development of ICVAs in SLE patients. Conversely, SAPS and aCl positivity, although associated with ICVAs, did not clearly correlate with LHVAs in our study. These results provide insight on the pathogenesis of ICVAs and may give clues on the potential efficacy of preventive/therapeutic strategies in different SLE subpopulations.

Key Words: heart valve abnormalities • SLE • stroke • TIA

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