Valvular dysfunction in antiphospholipid syndrome: Prevalence, clinical features, and treatment

https://doi.org/10.1016/S0049-0172(97)80034-0Get rights and content

Abstract

Valvular abnormalities develop in 36% and 35% of patients with primary antiphospholipid syndrome (PAPS) and with systemic lupus erythematosus (SLE) respectively, and in 48% of patients with SLE and antiphospholipid antibodies (aPL). Valvulopathy includes leaflet thickening, vegetations, regurgitation, and stenosis. A literature survey shows that significant morbidity from valvular dysfunction, mostly mitral regurgitation leading to congestive heart failure, occurs in 4% and 6% of SLE and PAPS patients, respectively. The pathogenesis of valvulopathy may involve interaction of aft with antigens on the valve surface, resulting in valvulitis. Current therapy includes symptomatic measures and valve replacement. A novel approach for symptomatic antiphospholipid syndrome (APS) related valvulopathy involves treatment with systemic corticosteroids. We describe four such patients and their dramatic clinical and hemodynamic response to treatment with prednisone when symptomatic measures failed.

References (42)

  • BulkleyB.F.I. et al.

    The heart in systemic lupus erythematosus and the changes induced in it by corticosteroid therapy: a study of 36 necropsy patients

    Am J Med

    (1975)
  • MoynihanT. et al.

    Simultaneous aortic and mitral valve replacement for lupus endocarditis: Report of a case and review of the literature

    J Thorac Cardiovasc Surg

    (1988)
  • DajeeH. et al.

    Cardiac valve replacement in systemic lupus erythematosus. A review

    J Thorac Cardiovasc Sting

    (1983)
  • DohertyN.E. et al.

    Cardiovascular manifestations of systemic lupus erythematosus

    Am Heart J

    (1988)
  • GalveE. et al.

    Prevalence, morphologic types, and evolution of cardiac valvular disease in systemic lupus erythematosus

    N Engl J Med

    (1988)
  • MeyerO. et al.

    Heart valve disease in systemic lupus erythematosus

    Clin Rev Allergy Immunol

    (1995)
  • GrozierI.G. et al.

    Cardiac involvement in systemic lupus erythematosus detected by echocardiography

    Am J Cardiol

    (1990)
  • SturfeltG. et al.

    Cardiovascular disease in systemic lupus erythematosus: A study of 75 patients from a defined population

    Medicine

    (1992)
  • EnomotoK. et al.

    Frequency of valvular regurgitation by color Doppler echocardiography in systemic lupus erythematosus

    Am J Cardiol

    (1988)
  • FordP.M. et al.

    Association of lupus anticoagulant with severe valvular heart disease in systemic lupus erythematosus

    J Rheumatol

    (1988)
  • CerveraR. et al.

    Cardiac disease in systemic lupus erythematosus: prospective study of 70 patients

    Ann Rheum Dis

    (1992)
  • Cited by (0)

    View full text