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Clinical characteristics and long-term outcomes of Libman-Sacks endocarditis in patients with systemic lupus erythematosus

 Byung-Woo Yoo  ;  Sang-Won Lee  ;  Jason Jungsik Song  ;  Yong-Beom Park  ;  Seung Min Jung 
 LUPUS, Vol.29(9) : 1115-1120, 2020-08 
Journal Title
Issue Date
Adult ; Antibodies, Antiphospholipid / blood ; Anticoagulants / therapeutic use ; Antiphospholipid Syndrome / complications* ; Disease Progression ; Echocardiography ; Endocarditis / diagnostic imaging ; Endocarditis / drug therapy* ; Endocarditis / etiology ; Female ; Humans ; Immunosuppressive Agents / therapeutic use ; Lupus Erythematosus, Systemic / complications* ; Prognosis ; Retrospective Studies ; Thromboembolism / prevention & control* ; Young Adult
Libman–Sacks endocarditis ; anticoagulation ; antiphospholipid syndrome ; non-bacterial endocarditis ; systemic lupus erythematosus
Objective: Treatment of Libman-Sacks (LS) endocarditis in patients with systemic lupus erythematosus (SLE) is challenging due to the lack of data. This study aimed to identify the clinical characteristics of SLE patients and LS endocarditis, and to investigate the treatment and prognosis of LS endocarditis.

Methods: Of all the patients with SLE who underwent echocardiography between 2010 and 2019, 11 and 29 patients with and without LS endocarditis, respectively, were included. We compared the inflammatory and thrombotic profiles between patients with and without LS endocarditis, and investigated the treatment and long-term outcome of LS endocarditis.

Results: No significant differences were observed in disease activity, clinical characteristics and inflammatory marker levels between patients with and without LS endocarditis. Patients with LS endocarditis had a significantly higher prevalence of antiphospholipid antibody (aPL) but a lower prevalence of SLE-specific antibody. Triple positivity of aPL was found in 72.7% and 13.8% of patients with and without LS endocarditis, respectively. Of 11 patients with LS endocarditis, six patients received anticoagulation therapy, and five patients received augmented immunosuppressive therapies. One patient who did not receive anticoagulation therapy developed cerebral infarction. Nine (82%) patients with LS endocarditis were classified as having antiphospholipid syndrome (APS). Despite the residual vegetation and valve dysfunction, surgical intervention was not required during the follow-up period of 56.8 months.

Conclusion: A significant correlation was observed between APS and LS endocarditis. Anticoagulation therapy should be considered to prevent thromboembolic complications in SLE patients with LS endocarditis.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Park, Yong Beom(박용범)
Song, Jason Jungsik(송정식) ORCID logo https://orcid.org/0000-0003-0662-7704
Yoo, Byung Woo(유병우)
Lee, Sang-Won(이상원) ORCID logo https://orcid.org/0000-0002-8038-3341
Jung, SeungMin(정승민) ORCID logo https://orcid.org/0000-0003-3465-2181
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