Libman-Sacks endocarditis and associated cerebrovascular disease: The role of medical therapy.
<h4>Background</h4>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 f...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2021-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0247052 |
| _version_ | 1819038073873235968 |
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| author | Carlos A Roldan Wilmer L Sibbitt Ernest R Greene Clifford R Qualls Rex E Jung |
| author_facet | Carlos A Roldan Wilmer L Sibbitt Ernest R Greene Clifford R Qualls Rex E Jung |
| author_sort | Carlos A Roldan |
| collection | DOAJ |
| description | <h4>Background</h4>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.<h4>Objective</h4>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.<h4>Methods and materials</h4>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.<h4>Results</h4>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).<h4>Conclusion</h4>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. |
| first_indexed | 2024-12-21T08:31:31Z |
| format | Article |
| id | doaj.art-058184ed89c348b9a4996af09aa474b6 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-21T08:31:31Z |
| publishDate | 2021-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-058184ed89c348b9a4996af09aa474b62022-12-21T19:10:12ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-01162e024705210.1371/journal.pone.0247052Libman-Sacks endocarditis and associated cerebrovascular disease: The role of medical therapy.Carlos A RoldanWilmer L SibbittErnest R GreeneClifford R QuallsRex E Jung<h4>Background</h4>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.<h4>Objective</h4>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.<h4>Methods and materials</h4>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.<h4>Results</h4>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).<h4>Conclusion</h4>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.https://doi.org/10.1371/journal.pone.0247052 |
| spellingShingle | Carlos A Roldan Wilmer L Sibbitt Ernest R Greene Clifford R Qualls Rex E Jung Libman-Sacks endocarditis and associated cerebrovascular disease: The role of medical therapy. PLoS ONE |
| title | Libman-Sacks endocarditis and associated cerebrovascular disease: The role of medical therapy. |
| title_full | Libman-Sacks endocarditis and associated cerebrovascular disease: The role of medical therapy. |
| title_fullStr | Libman-Sacks endocarditis and associated cerebrovascular disease: The role of medical therapy. |
| title_full_unstemmed | Libman-Sacks endocarditis and associated cerebrovascular disease: The role of medical therapy. |
| title_short | Libman-Sacks endocarditis and associated cerebrovascular disease: The role of medical therapy. |
| title_sort | libman sacks endocarditis and associated cerebrovascular disease the role of medical therapy |
| url | https://doi.org/10.1371/journal.pone.0247052 |
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