Libman-Sacks endocarditis and associated cerebrovascular disease: The role of medical therapy.

Abstract

BACKGROUND:

Libman-Sacks endocarditis in patients with systemic lupus erythematosus (SLE) is commonly complicated with embolic cerebrovascular disease (CVD) or valve dysfunction for which high-risk valve surgery is frequently performed. However, the role of medical therapy alone for Libman-Sacks endocarditis and associated acute CVD remains undefined.

OBJECTIVE:

To determine in this cross-sectional and longitudinal study if conventional anti-inflammatory and anti-thrombotic therapy may be an effective therapy in SLE patients with Libman-Sacks endocarditis and associated acute CVD.

METHODS AND MATERIALS:

17 SLE patients with Libman-Sacks endocarditis detected by two-and-three-dimensional transesophageal echocardiography (TEE) and complicated with acute CVD [stroke/TIA, focal brain injury on MRI, or cognitive dysfunction] were treated with conventional anti-inflammatory and anti-thrombotic therapy for a median of 6 months and then underwent repeat TEE, transcranial Doppler, brain MRI, and neurocognitive testing for re-assessment of Libman-Sacks endocarditis and CVD.

RESULTS:

Valve vegetations decreased in number, diameter, and area (all p ≤0.01); associated valve regurgitation significantly improved (p = 0.04), and valve thickening did not progress (p = 0.56). In 13 (76%) patients, valve vegetations or valve regurgitation resolved or improved in number and size or by ≥1 degree, respectively, as compared to 4 (24%) patients in whom vegetations or valve regurgitation persisted unchanged or increased in size or by ≥1 degree (p = 0.03). Also, cerebromicroembolism, lobar and global gray and white matter cerebral perfusion, ischemic brain lesion load, and neurocognitive dysfunction resolved or significantly improved (all p ≤0.04).

CONCLUSION:

These preliminary data suggest that combined conventional anti-inflammatory and antithrombotic therapy may be an effective treatment for Libman-Sacks endocarditis and its associated CVD and may obviate the need for high-risk valve surgery.

• Authors: Carlos A Roldan, Wilmer L Sibbitt Jr, Ernest R Greene, Clifford R Qualls, Rex E Jung
• Journal: PloS one (PLoS One) Vol. 16 Issue 2 Pg. e0247052 ( 2021) ISSN: 1932-6203 [Electronic] United States
• PMID: 33592060 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Topics

• Adult
• Cerebrovascular Disorders (immunology, metabolism)
• Echocardiography, Transesophageal
• Endocarditis (immunology, metabolism)
• Female
• Humans
• Inflammation (immunology, metabolism)
• Lupus Erythematosus, Systemic (immunology, metabolism)
• Magnetic Resonance Imaging
• Male
• Mental Status and Dementia Tests
• Middle Aged