Circulation, Vol 82, 369-375, Copyright © 1990 by American Heart Association
P Nihoyannopoulos, PM Gomez, J Joshi, S Loizou, MJ Walport and CM Oakley
Two-dimensional echocardiographic studies were prospectively performed in
93 patients with systemic lupus erythematosus (SLE) to discover the
incidence and spectrum of cardiac abnormalities and to relate these
findings to the presence of high levels of anticardiolipin antibodies.
Assessment of the intracardiac anatomy was also performed in an additional
12 patients who had increased anticardiolipin antibody levels but did not
have SLE. Fifty patients (54%) with SLE had cardiac abnormalities, and 43
patients (46%) had normal hearts. Three categories of cardiac abnormalities
were identified--valvular lesions, ranging from vegetations to valvular
thickening, were found in 28%, pericardial effusion or thickening was found
in 20%, and regional or global left ventricular dysfunction was found in
5%. High levels of anticardiolipin antibodies were detected in 50 patients
(54%) with SLE. Of those, only 11 (22%) had an entirely normal heart,
whereas the remaining 39 (78%) had at least one cardiac abnormality
(valvular lesions in 20, pericardial effusion in 15, and myocardial
dysfunction in five patients). In patients with SLE, the presence of
abnormal intracardiac anatomy was strongly associated with increased levels
of anticardiolipin antibodies (p less than 0.0001). The overall sensitivity
and specificity of high levels of anticardiolipin antibodies in the
prediction of cardiac abnormalities was 78% and 74%, respectively, with a
positive predictive accuracy of 78% and a negative predictive accuracy of
74%. Eight of the 12 patients (67%) who had increased anticardiolipin
antibodies but whose disease did not fulfill the American Rheumatism
Association classification criteria for SLE had cardiac abnormalities
similar to those in patients with SLE compared with only four (33%) who had
normal hearts (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Cardiac abnormalities in systemic lupus erythematosus. Association with raised anticardiolipin antibodies
Department of Medicine, Hammersmith Hospital, London, UK.
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