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102
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Ghosh B, Saha K, Ghosh A, Dhar S. Cardiovascular evaluation in patients with systemic lupus erythematosus—a cross sectional study. INDIAN JOURNAL OF RHEUMATOLOGY 2008. [DOI: 10.1016/s0973-3698(10)60139-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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103
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Kamata Y, Iwamoto M, Aoki Y, Kishaba Y, Nagashima T, Nara H, Kamimura T, Tanaka A, Yoshio T, Okazaki H, Minota S. Massive intractable pericardial effusion in a patient with systemic lupus erythematosus treated successfully with pericardial fenestration alone. Lupus 2008; 17:1033-5. [DOI: 10.1177/0961203308089437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Systemic lupus erythematosus (SLE) is often complicated by pericarditis with effusion, which generally responds well to glucocorticoid. We report herein a Japanese patient with SLE who showed a sign of cardiac tamponade and severe chest and back pain because of massive intractable pericardial effusion. Pulse glucocorticoid and pulse cyclophosphamide gained marginal effects. Pericardial effusion accumulated again soon after ultrasound-guided pericardiocentesis and drainage. Pericardial fenestration performed surgically as a last resort, for draining pericardial fluid into the pleural space, was very effective, and only a much smaller amount of fluid was observed in the space thereafter in comparison with the volume before the surgery. Pathological examination of the retrieved pericardium unfolded intense hyperplasia of small vessels and capillaries. Levels of IL-6 and TNF-α in pericardial effusion were extremely higher than those in serum. Pericardial effusion with extensive capillary hyperplasia in SLE would be resistant to medical treatment and require surgical fenestration.
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Affiliation(s)
- Y Kamata
- Division of Rheumatology and Clinical Immunology, Jichi Medical University, Tochigi-ken, Japan
| | - M Iwamoto
- Division of Rheumatology and Clinical Immunology, Jichi Medical University, Tochigi-ken, Japan
| | - Y Aoki
- Division of Rheumatology and Clinical Immunology, Jichi Medical University, Tochigi-ken, Japan
| | - Y Kishaba
- Department of Pathology, Jichi Medical University, Tochigi-ken, Japan
| | - T Nagashima
- Division of Rheumatology and Clinical Immunology, Jichi Medical University, Tochigi-ken, Japan
| | - H Nara
- Division of Rheumatology and Clinical Immunology, Jichi Medical University, Tochigi-ken, Japan
| | - T Kamimura
- Division of Rheumatology and Clinical Immunology, Jichi Medical University, Tochigi-ken, Japan
| | - A Tanaka
- Department of Pathology, Jichi Medical University, Tochigi-ken, Japan
| | - T Yoshio
- Division of Rheumatology and Clinical Immunology, Jichi Medical University, Tochigi-ken, Japan
| | - H Okazaki
- Division of Rheumatology and Clinical Immunology, Jichi Medical University, Tochigi-ken, Japan
| | - S Minota
- Division of Rheumatology and Clinical Immunology, Jichi Medical University, Tochigi-ken, Japan
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104
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Karoubi Nordon E, Hayem G, Mentre F, Palazzo E, Legrain S, Meyer O, Raveaud P. Letter to the Editor: Late onset systemic lupus erythematosus: A new approach. Lupus 2007; 16:1011-4. [DOI: 10.1177/0961203307077148] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- E. Karoubi Nordon
- Service de gériatrie, CHU Bichat-Claude Bernard, 46 rue Henri-Huchard, 75877 Paris Cedex, 18, France, /
| | - G. Hayem
- Service de rhumatologie, CHU Bichat-Claude Bernard, 46 rue Henri-Huchard, 75877 Paris Cedex, 18, France
| | - F. Mentre
- Service de biostatistiques, CHU Bichat-Claude Bernard, 46 rue Henri-Huchard, 75877 Paris Cedex 18, France
| | - E. Palazzo
- Service de rhumatologie, CHU Bichat-Claude Bernard, 46 rue Henri-Huchard, 75877 Paris Cedex, 18, France
| | - S. Legrain
- Service de gériatrie, CHU Bichat-Claude Bernard, 46 rue Henri-Huchard, 75877 Paris Cedex, 18, France
| | - O. Meyer
- Service de rhumatologie, CHU Bichat-Claude Bernard, 46 rue Henri-Huchard, 75877 Paris Cedex, 18, France
| | - P. Raveaud
- Service de rhumatologie, CHU Bichat-Claude Bernard, 46 rue Henri-Huchard, 75877 Paris Cedex, 18, France
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105
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Carroll L, Frazer IH, Turner M, Marwick TH, Thomas R. Receptor for advanced glycation end products Glycine 82 Serine polymorphism and risk of cardiovascular events in rheumatoid arthritis. Arthritis Res Ther 2007; 9:R39. [PMID: 17425804 PMCID: PMC1906817 DOI: 10.1186/ar2175] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Revised: 03/20/2007] [Accepted: 04/11/2007] [Indexed: 01/18/2023] Open
Abstract
Patients with rheumatoid arthritis (RA) are at risk of excess mortality, predominantly owing to cardiovascular (CV) events. The receptor for advanced glycation end products (RAGE) has been implicated in the perpetuation of the chronic inflammatory response in vascular disease. A Gly82→Ser polymorphism in the RAGE gene, which is associated with enhanced RAGE signaling, is present more frequently in patients with RA than the general population. To investigate whether RAGE Gly82→Ser polymorphism is associated with CV events in RA, we examined CV events, CV risk factors, features of RA and RAGE Gly82→Ser polymorphism in 232 patients with RA attending a tertiary referral hospital. CV events, the duration and severity of RA, and risk factors for CV disease were determined using patient questionnaires, chart review, laboratory analysis and radiographs. DNA was typed for HLA–DRB1 genes and RAGE Gly82→Ser polymorphism. The RAGE Ser82 allele, which is in linkage disequilibrium with the RA susceptibility allele HLA–DRB1*0401, was carried by 20% of patients. More than 20% of the cohort had suffered a vascular event; a shorter duration of RA, but not the RAGE genotype, was significantly associated with CV events. However, a history of statin use was protective. Thus, the RAGE Ser82 allele, associated with enhanced RAGE signaling, does not predispose to CV events in RA. However, treatment of hyperlipidemia with statins reduces the probability of a CV event.
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Affiliation(s)
- Lisa Carroll
- Diamantina Institute for Cancer, Immunology and Metabolic Medicine, University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane, Queensland 4102, Australia
| | - Ian H Frazer
- Diamantina Institute for Cancer, Immunology and Metabolic Medicine, University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane, Queensland 4102, Australia
| | - Malcolm Turner
- Diamantina Institute for Cancer, Immunology and Metabolic Medicine, University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane, Queensland 4102, Australia
| | - Thomas H Marwick
- Department of Medicine, University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane, Queensland 4102, Australia
| | - Ranjeny Thomas
- Diamantina Institute for Cancer, Immunology and Metabolic Medicine, University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane, Queensland 4102, Australia
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106
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Tweezer-Zaks N, Zandman-Goddard G, Lidar M, Har-Zahav Y, Livneh A, Langevitz P. A Long-Term Follow-up after Cardiac Transplantation in a Lupus Patient: Case Report and Review of the Literature. Ann N Y Acad Sci 2007; 1110:539-43. [PMID: 17911469 DOI: 10.1196/annals.1423.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Heart or heart-lung transplantations have only rarely been performed in patients with systemic lupus erythematosus (SLE), who like other patients with multi-system autoimmune diseases are traditionally excluded from consideration for such transplantations. In view of the limited experience with heart transplantation in these patients, we report the successful transplantation outcome in a lupus patient and review the literature in relation to graft and recipient conditions.
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Affiliation(s)
- Nurit Tweezer-Zaks
- Rheumatology Unit, Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Israel
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107
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Lockhart PB, Loven B, Brennan MT, Fox PC. The evidence base for the efficacy of antibiotic prophylaxis in dental practice. J Am Dent Assoc 2007; 138:458-74; quiz 534-5, 437. [PMID: 17403736 DOI: 10.14219/jada.archive.2007.0198] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION People with various medical conditions and devices are suggested candidates for receiving antibiotic prophylaxis before undergoing dental procedures. This practice is controversial, however, owing to the lack of proof of efficacy. The authors conducted a qualitative, systematic review to determine the level of evidence for this practice and whether antibiotic prophylaxis prevents distant site infections in these patients. METHODS The authors selected eight groups of patients with specific medical conditions and devices who often are given antibiotic prophylaxis before undergoing invasive dental procedures. The conditions and devices were cardiac-native heart valve disease, prosthetic heart valves and pacemakers; hip, knee and shoulder prosthetic joints; renal dialysis shunts; cerebrospinal fluid shunts; vascular grafts; immunosuppression secondary to cancer and cancer chemotherapy; systemic lupus erythematosus; and insulin-dependent (type 1) diabetes mellitus. The authors thoroughly searched the literature for the years 1966 through 2005 for references indicating some level of support for this practice and graded each publication on the basis of level of evidence. RESULTS The authors found formal recommendations in favor of antibiotic prophylaxis for only three of the eight medical conditions: native heart disease, prosthetic heart valves and prosthetic joints. They found no prospective randomized clinical trials and only one clinical study of antibiotic prophylaxis. Only one systematic review and two case series provided weak, if any, support for antibiotic prophylaxis in patients with cardiac conditions. The authors found little or no evidence to support this practice or to demonstrate that it prevents distant site infections for any of these eight groups of patients. CONCLUSIONS No definitive, scientific basis exists for the use of prophylactic antibiotics before dental procedures for these eight groups of patients.
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Affiliation(s)
- Peter B Lockhart
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC 28232-2861, USA.
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108
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Chung JW, Joe DY, Park HJ, Kim HA, Park HS, Suh CH. Clinical characteristics of lupus myocarditis in Korea. Rheumatol Int 2007; 28:275-80. [PMID: 17634899 DOI: 10.1007/s00296-007-0414-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 06/24/2007] [Indexed: 11/29/2022]
Abstract
Clinically important myocarditis is an unusual feature in systemic lupus erythematosus (SLE). We describe the clinical characteristics, management and outcomes of five SLE patients who developed severe left ventricular dysfunction. Four patients were female with mean age of 36.4 years. Three patients had both lupus myocarditis and lupus nephritis. Four patients had raised anti-dsDNA antibody titer and low complement level and two patients had positive IgG anticardiolipin antibody. Three patients were treated by high-dose corticosteroids, one patient by intravenous pulse methylprednisolone, and one patient by intravenous immunoglobulin and pulse cyclophosphamide with high dose corticosteroids. Left ventricular function improved markedly in four patients and all of them had no recurrence of lupus myocarditis up to follow-up of 33 months. However, one patient, who showed no improvement of left ventricular function, was expired due to sudden cardiac arrest. Lupus myocarditis should be treated by immunosuppressive therapy with high-dose corticosteroids and mostly the prognosis might be good with early treatment.
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Affiliation(s)
- Jae-Wook Chung
- Department of Allergy and Rheumatology, Ajou University School of Medicine, Suwon, South Korea
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109
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Moyssakis I, Tektonidou MG, Vasilliou VA, Samarkos M, Votteas V, Moutsopoulos HM. Libman-Sacks endocarditis in systemic lupus erythematosus: prevalence, associations, and evolution. Am J Med 2007; 120:636-42. [PMID: 17602939 DOI: 10.1016/j.amjmed.2007.01.024] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2006] [Revised: 12/21/2006] [Accepted: 01/12/2007] [Indexed: 11/30/2022]
Abstract
PURPOSE We evaluated the prevalence and progression of Libman-Sacks endocarditis in patients with systemic lupus erythematosus and any association between this valvulopathy and their clinical and laboratory characteristics. METHODS Doppler echocardiography was performed in 342 consecutive patients with systemic lupus erythematosus (297 females and 45 males). The clinical and laboratory data were recorded. Patients were reevaluated after a follow-up period of 4 years. RESULTS Libman-Sacks endocarditis was found in 38 patients (11%). In 24 of 38 patients, mitral valve involvement was found, resulting in regurgitation in all (mild in 18, moderate in 4, and severe in 2), whereas stenosis co-occurred with regurgitation in 9 patients (mild in 6 and moderate in 3). Thirteen (34%) of 38 patients had aortic valve involvement; 11 had regurgitation (mild) and 8 had stenosis (mild), coexistent with regurgitation in 6 of them. One patient had mild tricuspid regurgitation. A significant association was found between Libman-Sacks endocarditis and disease duration and activity, thromboses, stroke, thrombocytopenia, anticardiolipin antibodies, and antiphospholipid syndrome. During the follow-up period, 252 of 342 patients were reevaluated echocardiographically. Among the 38 patients with Libman-Sacks vegetations, 5 with mild mitral regurgitation at the beginning developed moderate (n=4) and severe mitral regurgitation (n=1), 2 patients with mitral stenosis (mild in 1 and moderate in 1) developed severe mitral regurgitation, and 2 patients with mild aortic regurgitation developed moderate and severe mitral regurgitation, whereas a significant deterioration of aortic stenosis was found. Two patients who were candidates for surgery died. Among the 213 patients without vegetations at the beginning, 8 developed new Libman-Sacks lesions. CONCLUSIONS Libman-Sacks vegetations can be found in approximately 1 of 10 patients with systemic lupus erythematosus, and they are associated with lupus duration, disease activity, anticardiolipin antibodies, and antiphospholipid syndrome manifestations. A progression of valve lesions may occur during long-term follow-up.
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110
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Nielsen TD, Steenbergen C, Russell SD. Nonischemic cardiomyopathy associated with autoimmune polyglandular syndrome type II. Endocr Pract 2007; 13:59-62. [PMID: 17360303 DOI: 10.4158/ep.13.1.59] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To report a case of nonischemic cardiomyopathy associated with autoimmune polyglandular syndrome type II (APS-II). METHODS We describe our patient's clinical features, evaluation, and outcome. In addition, a literature review of cardiomyopathy associated with polyendocrinopathy syndromes is presented. RESULTS The component disorders of APS-II are Addison's disease in combination with either autoimmune thyroid disease or type 1 (insulin-dependent) diabetes. Although numerous other autoimmune conditions have been reported in conjunction with APS-II, cardiomyopathy has not been previously described as part of this syndrome. The current patient was a 32-year-old man who, during a 5-year period, was diagnosed as having type 1 diabetes mellitus, Crohn's disease, and Addison's disease. In 2001, he presented with severe heart failure that progressed rapidly and eventually necessitated cardiac transplantation. CONCLUSION Although autoimmune cardiomyopathy has been associated with other autoimmune disorders, to our knowledge this is the first reported case of cardiomyopathy in association with an autoimmune polyglandular syndrome. Patients with this syndrome should undergo clinical evaluation for heart failure.
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Affiliation(s)
- Thomas D Nielsen
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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111
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Abstract
Viruses are the most common cause of myocarditis in economically advanced countries. Enteroviruses and adenoviruses are the most common etiologic agents. Viral myocarditis is a triphasic process. Phase 1 is the period of active viral replication in the myocardium during which the symptoms of myocardial damage range from none to cardiogenic shock. If the disease process continues, it enters phase 2, which is characterized by autoimmunity triggered by viral and myocardial proteins. Heart failure often appears for the first time in phase 2. Phase 3, dilated cardiomyopathy, is the end result in some patients. Diagnostic procedures and treatment should be tailored to the phase of disease. Viral myocarditis is a significant cause of dilated cardiomyopathy, as proved by the frequent presence of viral genomic material in the myocardium, and by improvement in ventricular function by immunomodulatory therapy. Myocarditis of any etiology usually presents with heart failure, but the second most common presentation is ventricular arrhythmia. As a result, myocarditis is one of the most common causes of sudden death in young people and others without preexisting structural heart disease. Myocarditis can be definitively diagnosed by endomyocardial biopsy. However, it is clear that existing criteria for the histologic diagnosis need to be refined, and that a variety of molecular markers in the myocardium and the circulation can be used to establish the diagnosis. Treatment of myocarditis has been generally disappointing. Accurate staging of the disease will undoubtedly improve treatment in the future. It is clear that immunosuppression and immunomodulation are effective in some patients, especially during phase 2, but may not be as useful in phases 1 and 3. Since myocarditis is often selflimited, bridging and recovery therapy with circulatory assistance may be effective. Prevention by immunization or receptor blocking strategies is under development. Giant cell myocarditis is an unusually fulminant form of the disease that progresses rapidly to heart failure or sudden death. Rapid onset of disease in young people, especially those with other autoimmune manifestations, accompanied by heart failure or ventricular arrhythmias, suggests giant cell myocarditis. Peripartum cardiomyopathy in economically developed countries is usually the result of myocarditis.
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Affiliation(s)
- James T. Willerson
- The University of Texas Health Science Center in Houston, Houston, ,Texas Heart Institute, Houston, TX USA
| | - Hein J. J. Wellens
- Department of Cardiology, University of Maastricht, Masstricht, The Netherlands
| | - Jay N. Cohn
- Rasmussen Center for Cardiovascular Disease Prevention Cardiovascular Division, University of Minnesota, Minneapolis, MN USA
| | - David R. Holmes
- Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN USA
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112
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Moyssakis I, Tzioufas A, Triposkiadis F, Strateges N, Kyriakidis M. Severe aortic stenosis and mitral regurgitation in a woman with systemic lupus erythematosus. Clin Cardiol 2006; 25:194-6. [PMID: 12000079 PMCID: PMC6654694 DOI: 10.1002/clc.4960250412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Libman-Sacks endocarditis complicating systemic lupus erythematosus has rarely been reported to cause hemodynamically significant valvular lesions. This report presents a case of severe aortic stenosis combined with severe mitral regurgitation associated with systemic lupus erythematosus in a young woman who died while on the quota list for surgery.
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Affiliation(s)
- Ioannis Moyssakis
- University of Athens, Medical School, Department of Cardiology, Laikon Hospital, Greece
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113
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Düzgün N, Mete T. Premature myocardial infarction in a young woman with systemic lupus erythematosus. Rheumatol Int 2006; 27:115-6. [PMID: 16964479 DOI: 10.1007/s00296-006-0209-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Accepted: 07/23/2006] [Indexed: 11/28/2022]
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114
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Gutiérrez-Macías A, Lizarralde-Palacios E, Cabeza-García S, Miguel-De la Villa F. Cardiac tamponade as the first manifestation of systemic lupus erythematosus in the elderly. Am J Med Sci 2006; 331:342-3. [PMID: 16775446 DOI: 10.1097/00000441-200606000-00012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although pericardial involvement is very frequent in systemic lupus erythematosus, cardiac tamponade is extremely rare as the first manifestation of the disease. On the other hand, systemic lupus erythematosus is a disease that predominantly affects young women, and it is a very uncommon condition in the elderly. We report a 91-year-old woman diagnosed with cardiac tamponade, which was the presenting clinical feature of a previously undiagnosed case of systemic lupus erythematosus.
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115
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Klinkner DB, Densmore JC, Kaul S, Noll L, Lim HJ, Weihrauch D, Pritchard KA, Oldham KT, Sander TL. Endothelium-derived microparticles inhibit human cardiac valve endothelial cell function. Shock 2006; 25:575-80. [PMID: 16721264 DOI: 10.1097/01.shk.0000209558.69575.80] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Elevated numbers of endothelium-derived microparticles (EMPs) in the circulation are found in a variety of critical illnesses. EMPs have been associated with vascular dysfunction, including thrombotic complications and loss of normal vascular reactivity, common responses associated with cardiac valve injury. However, the exact mechanisms of this dysfunction and the potential impact on cardiac endothelium are unknown. We hypothesize that pathologic levels of circulating EMPs negatively regulate proliferation and migration of valvular endothelial cells (ECs), leading to downstream endothelial dysfunction. EMPs were generated from plasminogen activation inhibitor 1-stimulated human umbilical vein endothelial cells (HUVECs). Human mitral valve endothelial cells (HMVECs) were isolated and characterized by platelet endothelial cell-derived adhesion molecule-1 (PECAM-1, or CD31) and von Willebrand factor immunocytochemistry. HMVECs were treated with increasing EMP doses, and then, the effects of EMPs on growth factor-induced proliferation and migration were tested. Proliferation was assessed by H-thymidine incorporation. EC migration was assayed by photographing microtubules of HMVECs and HUVECs in fibrin gel incubated with EMPs +/- growth factors for 48 h. The EMP effects on non-valve HUVECs were tested in parallel. EMPs inhibited HMVEC proliferation at high doses but stimulated HUVEC proliferation at all doses. In HMVECs, EMPs inhibited basic fibroblast growth factor- and vascular endothelial growth factor-induced proliferation and migration. Taken together, these data suggest EMPs regulate valvular EC proliferation in a dose-dependent manner and, furthermore, modulate growth factor signaling in ECs. These results implicate EMPs as a possible source of downstream EC dysfunction in disease states. EMPs may play a role in valvular leaflet injury in human disease by inhibiting normal growth and repair of endothelium.
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Affiliation(s)
- Denise B Klinkner
- Department of Surgery, Division of Pediatric Surgery, Medical College of Wisconsin and Children's Research Institute, Milwaukee, WI 53226, USA
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116
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Christodoulou C, Zain M, Bertolaccini ML, Sangle S, Khamashta MA, Hughes GRV, D'Cruz DP. Prevalence of an abnormal ankle-brachial index in patients with antiphospholipid syndrome with pregnancy loss but without thrombosis: a controlled study. Ann Rheum Dis 2006; 65:683-4. [PMID: 16611867 PMCID: PMC1798133 DOI: 10.1136/ard.2005.037911] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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117
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Chadha T, Hernandez JE. Infliximab-related lupus and associated valvulitis: A case report and review of the literature. ACTA ACUST UNITED AC 2006; 55:163-6. [PMID: 16463396 DOI: 10.1002/art.21702] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tina Chadha
- Baylor College of Medicine, One Baylor Plaza, Suite 672E, BCM 285, Houston, TX 77030, USA.
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118
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Schotte H, Becker H, Domschke W, Gaubitz M. [Cardiovascular monitoring of patients with systemic lupus erythematosus]. Z Rheumatol 2005; 64:564-75. [PMID: 16328762 DOI: 10.1007/s00393-005-0668-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2004] [Accepted: 10/05/2004] [Indexed: 11/28/2022]
Abstract
Accelerated atherosclerotic cardiovascular disease is increasingly recognized as a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Cardiac manifestations of SLE are frequent and can involve almost all components of the heart. Pulmonary hypertension often develops during the course of SLE. The high incidence of cardiovascular complications may justify a screening of SLE patients in order to ensure early diagnosis and therapy. Results of diagnostic procedures that detect coronary insufficiency, surrogates of atherosclerotic burden and echocardiographic findings are often abnormal in SLE. However, evidence to support a routine screening for cardiovascular disease is currently not available. Therefore, based on the recommendations that have been proposed for other conditions associated with cardiovascular disease, we suggest assessment of risk factors and the performance of echocardiography at least annually in asymptomatic SLE patients. If two or more risk factors are present, an exercise ECG is recommended. The benefit, however, of screening SLE patients for cardiovascular disease has to be confirmed in prospective studies.
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Affiliation(s)
- H Schotte
- Medizinische Klinik und Poliklinik B, Universitätsklinikum Münster, Albert-Schweitzer-Str. 33, 48129 Münster, Germany.
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119
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Mattu A, Petrini J, Swencki S, Chaudhari C, Brady WJ. Premature atherosclerosis and acute coronary syndrome in systemic lupus erythematosus. Am J Emerg Med 2005; 23:696-703. [PMID: 16140181 DOI: 10.1016/j.ajem.2004.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2004] [Accepted: 12/22/2004] [Indexed: 10/25/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a vasculitic disorder with potential for multisystem organ dysfunction. Among the organ systems affected is the cardiovascular system. Patients with SLE are prone to premature atherosclerosis; this premature atherosclerosis places the patient at risk for myocardial infarction with onset at a relatively young age. We present 4 patients with SLE who experienced myocardial infarction; these patients also experienced diagnostic and treatment delays because of their relatively young age at presentation. Relevant pathophysiology and diagnostic strategies are discussed.
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Affiliation(s)
- Amal Mattu
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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120
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Lagogianni I, Papapanagiotou A, Piperi C, Kalofoutis C, Troupis G, Zachari A, Kalofoutis A. Evidence of reduced plasma HDL subfractions in patients with cutaneous discoid lupus erythematosus. Clin Biochem 2005; 38:286-90. [PMID: 15708553 DOI: 10.1016/j.clinbiochem.2004.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2004] [Revised: 10/11/2004] [Accepted: 10/20/2004] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of the present study was to evaluate the dyslipidemic profile of patients with Cutaneous Discoid Lupus Erythematosus (DLE) with particular emphasis on the levels of High Density Lipoprotein (HDL) Cholesterol and its subfractions, HDL2 and HDL3. DESIGN AND METHOD The study involved characterization of the lipid profile of 30 patients with diagnosed DLE (11 male and 19 female) and 34 age- and BMI-matched healthy individuals. RESULTS Patients with DLE presented increased serum cholesterol, triglycerides and LDL-Cholesterol levels (P < 0.001, respectively) compared to the control group, while the levels of HDL-Cholesterol (P < 0.001), as well as its subfractions, HDL2 (P < 0.001) and HDL3 (P < 0.02) were markedly decreased. In addition, the ratio of CHOL/HDL was increased in patients with DLE (P < 0.001), whereas a reduction was observed in the ratio of HDL2/HDL3 (P < 0.001) in the same group. CONCLUSIONS Our findings suggest that patients with cutaneous discoid lupus erythematosus have an increased risk of atherosclerosis due to the marked dyslipidemia associated with the disease. The reduced levels of HDL subfractions, HDL2 and HDL3, are believed to contribute to the dyslipidemic profile and further provide an important target for therapeutic intervention.
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Affiliation(s)
- Irene Lagogianni
- Department of Biological Chemistry, University of Athens School of Medicine, Goudi 74, Athens 11527, Greece
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121
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Grenader T, Shavit L. Intravenous immunoglobulin in treatment of cardiac tamponade in a patient with systemic lupus erythematosus. Clin Rheumatol 2005; 23:530-2. [PMID: 15801072 DOI: 10.1007/s10067-004-0931-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We describe a 23-year-old female patient with a history of systemic lupus erythematosus and pulmonary hypertension who developed a large pericardial effusion with cardiac tamponade. Invasive interventions such as pericardial window or pericardiectomy were ruled out because of the posterior localization of the effusion and high risk of general anesthesia in a patient with severe pulmonary hypertension. The patient received high-dose steroids intravenously with no response. A 5-day course of intravenous immunoglobulin resulted in gradual decrease of the pericardial effusion and resolution of cardiac tamponade within 2 weeks.
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Affiliation(s)
- Tal Grenader
- Department of Medicine, Hadassah University Hospital, PO Box 12000, 91120 Jerusalem, Israel.
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122
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Cacciapuoti F, Galzerano D, Capogrosso P, Arciello A, Liberti D, Cacciapuoti F, Lama D. Impairment of Left Ventricular Function in Systemic Lupus Erythematosus Evaluated by Measuring Myocardial Performance Index with Tissue Doppler Echocardiography. Echocardiography 2005; 22:315-9. [PMID: 15839986 DOI: 10.1111/j.1540-8175.2005.04015.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In 44 patients affected by systemic lupus erythematosus (SLE) without any clinical signs of heart disease (group I) the myocardial performance index (MPI) was calculated to investigate left ventricular function. The index, as the sum of isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT) divided by ejection time (ET), was measured by tissue Doppler echocardiography (TDE). Results achieved show a prolonged MPI with respect to the values recorded in healthy controls (group II). Its prolongation is due to a significant increase of IRT, whereas ICT and ET were within the normal limits. In patients with SLE without an evident cardiac engagement, this outcome seems to depend on a prevalent diastolic left ventricular dysfunction, perhaps due to a subclinical myocarditis. TDE is more precise than the conventional Doppler method in evaluating MPI and single time intervals, because their measurements are accomplished in concomitance of left ventricular wall motion rather than the flow movement.
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Affiliation(s)
- Federico Cacciapuoti
- Division of Internal Medicine and Metabolic Disease, Second University of Naples, Naples, Italy
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123
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Letranchant L, Ruivard M, Dauphin C, Chanet V, Philippe P. [Non infectious endocarditis: retrospective study (6 cases)]. Rev Med Interne 2005; 26:189-95. [PMID: 15777581 DOI: 10.1016/j.revmed.2004.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2004] [Accepted: 11/29/2004] [Indexed: 11/25/2022]
Abstract
PURPOSE If there is cardiac valve vegetation and the blood cultures are negatives we need to look for slow growing bacteria, fungi, Legionella pneumophilia, Bartonella henselae and quintana, Brucella melitensis and abortus, Coxiella burneti, Chlamydiae pneumoniae by serologic tests. The diagnosis of non- infectious endocarditis could be considered only if these results were negative. The main purpose of this study was to describe the clinical and echocardiographic signs of non-infectious endocarditis cases observed in two different wards. METHODS This study was done retrospectively during a five-year period in a cardiology and an internal medicine wards. The selection criteria are: the proof of at least one cardiac valve vegetation, observed on echocardiography, negative blood cultures and negative serologic tests as described above. RESULTS Six non-bacterial endocarditis were described. Four Libman-Sacks endocarditis, two associated with a primary antiphospholipid syndrome revealed by an acute ischemia of leg for one patient and by an eclampsia for another and the other two associated with a systemic lupus erythematous revealed by fever for one patient and by neurologic symptoms for the other. One fibroblastic endocarditis associated to an essential hypereosinophilia and one marastic endocarditis associated to a metastatic mucin-producing cancer. CONCLUSIONS For these six cases, a complete physical examination, a CBC for hypereosinophylia, a dosage of antiphospholipid antibodies and a thoraco-abdominal CT-scan allowed the etiologic diagnosis of non infectious endocarditis. Libman Sacks endocarditis associated with an antiphospholipid syndrome is the main etiology for which a long-term anticoagulation treatment was not followed.
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Affiliation(s)
- L Letranchant
- Service de médecine interne et hématologie, Hôtel-Dieu, CHU de Clermont-Ferrand, boulevard Malfrey, 63038 Clermont-Ferrand cedex 01, France.
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124
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Abstract
This article provides an overview of diagnosis and treatment of college students with possible congenital or acquired heart problem issues. Preventive cardiac concerns and issues regarding risk factors for atherosclerotic heart disease are discussed. College students with corrected or palliated heart conditions are included because they are an expanding segment of the adult cardiac population. Selected major syndromes with associated cardiac anomalies and complications are included. Finally, reinforcement and review of cardiac diagnosis or management issues occurring in college students (six case scenarios) are included in the appendix.
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Affiliation(s)
- Eugene F Luckstead
- Department of Pediatrics, Texas Tech Medical School-Amarillo, 1500 Coulter Street, Amarillo, TX 79106, USA.
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125
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Ward MM. Outcomes of hospitalizations for myocardial infarctions and cerebrovascular accidents in patients with systemic lupus erythematosus. ACTA ACUST UNITED AC 2004; 50:3170-6. [PMID: 15476215 DOI: 10.1002/art.20556] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Patients with systemic lupus erythematosus (SLE) have increased risks of acute myocardial infarction (AMI) and cerebrovascular accident (CVA), but it is not known whether they have worse outcomes after AMI or CVA compared with patients without SLE. This study compared in-hospital mortality, length of stay, and other measures of severity (congestive heart failure or need for coronary artery bypass grafting after AMI; discharge to a skilled nursing facility after CVA) between patients with SLE and patients without SLE who were hospitalized for AMI or CVA. METHODS Data on all patients hospitalized in California with either AMI or CVA from 1996 to 2000 were abstracted from a state hospitalization database. Outcomes after AMI were compared between 519 patients with SLE and 214,771 patients without SLE, and outcomes after CVA were compared between 905 patients with SLE and 293,326 patients without SLE. Analyses were performed separately for men and women. RESULTS Among women with AMI, there were no differences in the risk of in-hospital mortality, long length of stay, or congestive heart failure between patients with SLE and those without SLE, but women with SLE were less likely to undergo coronary artery bypass grafting. Outcomes after AMI did not differ between men with SLE and men without SLE. Among women with CVA, there were no differences in outcomes between patients with SLE and patients without SLE. Men with SLE were almost twice as likely to have a long length of stay after CVA than were men without SLE. CONCLUSION Outcomes after AMI and CVA are generally similar between patients with SLE and those without SLE.
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Affiliation(s)
- Michael M Ward
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland, USA20892-1828.
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126
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Griveas I, Sourgounis A, Visvardis G, Zarifis I, Kyriklidou P, Sakellariou G. Immunoadsorption in lupus myocarditis. Ther Apher Dial 2004; 8:281-5. [PMID: 15274678 DOI: 10.1111/j.1526-0968.2004.00165.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Reduction of pathological autoantibodies may be useful in the treatment of systemic lupus erythematosus (SLE). On the other hand clinically manifested myocarditis in SLE, though uncommon, may be life-threatening and its pathogenesis has been ascribed to autoimmunity. The aim of this study is to present a rare case of a patient with severe lupus myocarditis, where immunoadsorption (IA) was evaluated as rescue therapy. A case of SLE with initial manifestation of myocarditis is reported in a 29-year-old male who presented with arthritis, fever, lymphadenopathy, joint swelling and morning stiffness. Laboratory evaluation revealed increased antinuclear antibody (ANA), slightly decreased complement and positive anticoagulant panel. From the above clinical and laboratory features, criteria of SLE seemed applicable. During his hospitalization, the patient developed pericardial effusion and cardiogenic shock. Although pericardiotomy was performed and was treated with immunosuppressive agents, plasmapheresis and supported with current medications, his clinical condition remained critical with an ejection fraction of 20%. At this point it was decided to receive IA onto staphylococcal protein A. After 6 sessions with IA and concomitant immunosuppression, the patient responded well, his condition improved and was dismissed with an ejection fraction of 50%. Fulminant lupus myocarditis is a severe and rare situation lacking a satisfying specific therapy available today. In our presented case, IA in addition to immunosuppressive therapy was beneficial. Considering the benefits of our case and the current knowledge, it might be useful to clarify the open question in scale pilot studies.
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Affiliation(s)
- Ioannis Griveas
- Nephrology Department, Papageorgiou General Hospital, Thessaloniki, Greece.
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127
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Pulerwitz TC, Cappola TP, Felker GM, Hare JM, Baughman KL, Kasper EK. Mortality in primary and secondary myocarditis. Am Heart J 2004; 147:746-50. [PMID: 15077094 DOI: 10.1016/j.ahj.2003.10.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Lymphocytic myocarditis presents as a primary disorder or in association with a systemic disease. Whether primary and secondary myocarditis have the same prognosis is unknown. METHODS Patients (n = 171) referred to the Johns Hopkins Cardiomyopathy service from 1984 to 1998 with newly diagnosed cardiomyopathy were observed for an average of 5.9 years after an original diagnosis of biopsy-proven myocarditis or until reaching the end point of death. Giant-cell myocarditis was excluded from this study. Myocarditis was classified as secondary when a systemic disease was present at the time of presentation; otherwise, myocarditis was classified as primary. Survival rates among patients with primary and secondary myocarditis were compared with Kaplan-Meier analysis and Cox proportional hazard models incorporating clinical variables, including baseline hemodynamics and treatment with immunosuppressive therapy. RESULTS The mortality rate associated with secondary myocarditis varied substantially depending on the underlying systemic disorder. Peripartum myocarditis, when compared with idiopathic myocarditis, had a reduced mortality rate (relative hazard, 0.23 [0.06-0.98]; P <.05), which was attenuated after controlling for confounding variables (relative hazard, 0.62 [0.13-2.98]; P =.55). In contrast, human immunodeficiency virus myocarditis had a particularly poor prognosis (relative hazard, 6.70 [3.51-12.79]; P <.05), even after controlling for confounding variables. Myocarditis associated with systemic inflammatory disorders showed a trend toward increased mortality rate (relative hazard, 2.46 [0.65-9.38]; P =.19). For both primary and secondary myocarditis, advanced age and pulmonary hypertension were important clinical predictors of death. CONCLUSIONS The prognosis of patients with secondary myocarditis, when compared with patients with idiopathic myocarditis, seems most affected by the primary disease process.
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Affiliation(s)
- Todd C Pulerwitz
- Cardiology Division, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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128
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Chan YK, Li EK, Tam LS, Chow LTC, Ng HK. Intravenous cyclophosphamide improves cardiac dysfunction in lupus myocarditis. Scand J Rheumatol 2004; 32:306-8. [PMID: 14690145 DOI: 10.1080/03009740310003956] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We describe a Chinese woman who developed severe heart failure 3 years from the onset of systemic lupus erythematosus (SLE). Endomyocardial biopsy confirmed lupus myocarditis, with focal infiltrates of small lymphocytes and some polymorphic neutrophils. The conventional treatment for cardiac failure plus oral prednisolone failed to bring clinical and echocardiographical improvement until the addition of intravenous (i.v.) 'pulse' cyclophosphamide. Three weeks after i.v. cyclophosphamide treatment, there was significant improvement of her heart failure symptoms with improvement in the ejection fraction from 19% to 63%.
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Affiliation(s)
- Y K Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PRC.
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129
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de Pablo P, Ramírez A, Cortina E, de la Peña A, Zamora J, Izaguirre R, Amigo MC. Increased fibrin polymerization rate in patients with primary antiphospholipid syndrome and systemic lupus erythematosus. Clin Appl Thromb Hemost 2003; 9:221-5. [PMID: 14507110 DOI: 10.1177/107602960300900306] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The main event in blood coagulation is the thrombincatalyzed conversion of fibrinogen into fibrin. This singular transformation of a soluble protein into an insoluble polymeric network occurs with faultless precision. Abnormalities of fibrin polymerization can lead to hemorragic and thrombotic disorders. Increased fibrinogen plasma concentration (Fg) and fibrin polymerization rate (FPR) could be additional risk factors associated with atherothrombosis in antiphospholipid syndrome (APS) and in systemic lupus erythematosus (SLE). Our objective was to investigate Fg and FPR in consecutive patients with APS and SLE. Thirty-nine patients and 31 age- and gender-matched healthy controls were studied. Sixteen patients had primary APS, 13 patients had SLE, and 10 patients had SLE plus APS. The mean of the FPR was significantly increased (0.2799 +/- 0.091) in patients with APS plus SLE as compared with the control group (0.2052 +/- 0.055) (p < 0.05). Fg was higher in APS plus SLE (3.15 g/L +/- 0.43) and in primary APS (3.03 g/L +/- 0.29) than in controls (2.87 g/L +/- 0.49). Our results demonstrated an increased FPR in patients with APS plus SLE. This phenomenon could be an additional risk factor for thrombosis in these autoimmune diseases.
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Affiliation(s)
- Paola de Pablo
- Department of Rheumatology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
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130
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Lin CC, Ding HJ, Chen YW, Wang JJ, Ho ST, Kao A. Usefulness of technetium-99 m sestamibi myocardial perfusion SPECT in detection of cardiovascular involvement in patients with systemic lupus erythematosus or systemic sclerosis. Int J Cardiol 2003; 92:157-61. [PMID: 14659847 DOI: 10.1016/s0167-5273(03)00106-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The main purpose of the study was to evaluate the utility of technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography (Tc-99m sestamibi SPECT) in detection of cardiac involvement in systemic lupus erythematosus (SLE) or systemic sclerosis (SS) patients. Fifty SLE or SS female patients with cardiac symptom/sign such as chest discomfort and/or dyspnea and/or occasionally palpitation and 50 SLE or SS female patients without any cardiac symptom/sign were investigated using Tc-99m sestamibi SPECT during rest and stress after dipyridamole infusion. Twenty-five age- and sex-matched healthy females were also included as controls in this study. The results of Tc-99m sestamibi SPECT were classified into four types including normal, persistent perfusion defect (PD), reversible perfusion defect (RD), and reverse perfusion defect (RR). The results of Tc-99m sestamibi SPECT in the 25 healthy females were normal. Perfusion abnormalities were detected in 44/50 (88%) symptomatic SLE or SS patients. However, myocardial perfusion abnormalities were only detected in 19/50 (38%) asymptomatic SLE or SS patients (P value<0.05 by a chi2 test). However, for risk factor of coronary artery disease and abnormal resting EKG, the incidences were not significant between symptomatic and asymptomatic patients (P values >0.05 by a chi2 test). Tc-99m sestamibi SPECT is a useful noninvasive imaging modality to detect cardiac involvement in symptomatic or asymptomatic SLE or SS patients.
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Affiliation(s)
- Ching-Cheng Lin
- Cardiovascular Division, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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131
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Abstract
Valvular involvement is the most encountered form of heart disease in systemic lupus erythematosus (SLE). Immunoglobulin and complement deposition in the valvular structure will subsequently lead to Libman-Sacks vegetations, valve thickening, and valve regurgitation. Valvular stenosis is rarely seen. Involvement of the mitral valve is most frequently encountered. Valve disease for most patients is mild and asymptomatic, but patients in whom severe mitral regurgitation develops will present with symptoms of congestive heart failure. A heart murmur will be heard in almost all patients with moderate or severe regurgitation. Transesophageal echocardiography is the most sensitive method to detect the valvular involvement. The valvular changes, the hemodynamic status, or the symptomatology have been shown to progress, remain stable, or sometimes improve. Severe regurgitation, infective endocarditis, and thromboembolic events (mostly stroke or transitory ischemic attacks) are complications of valvular involvement in SLE. In treatment of these patients, prophylaxis of infectious endocarditis, selective antiaggregant and anticoagulant medication, and valve replacement are currently offered. The role of corticosteroid treatment is still unclear in the outcome of SLE valvulopathy.
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Affiliation(s)
- Adrian Fluture
- Department of Medicine/Internal Medicine, New York Medical College/Metropolitan Hospital Center, 1901 First Avenue, New York, NY 10029, USA
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132
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Sung JM, Hsu SC, Chen FF, Huang JJ. Systemic lupus erythematosus presented as non-inflammatory necrotizing vasculopathy-induced ischemic glomerulopathy and small vessels-related ischemic cardiomyopathy. Lupus 2003; 11:458-62. [PMID: 12195789 DOI: 10.1191/0961203302lu228cr] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The clinical significance of lupus non-inflammatory necrotizing vasculopathy (NINV) is not well established. For example, since lupus renal NINV is usually reported to coexist with proliferative and active glomerulonephritis, it is difficult to demonstrate the role of NINV on renal pathophysiology. Here we report a 16-year-old SLE boy with renal NINV presenting as ischemic glomerulopathy and small vessels-related ischemic heart failure. The renal biopsy demonstrated mild proliferative glomerulonephritis and NINV initially, and one month later repeated renal biopsy showed NINV with ischemic glomerulopathy. These findings established that NINV, but not proliferative glomerulonephritis, was responsive for his acute renal failure (ARF). Another interesting question is about the pathophysiology of his myocardial dysfunction. This patient presented typical angina and congestive heart failure (CHF). Echocardiograms and ventriculography revealed dilatation of four chambers and low ejection fraction. Serial electrocardiograms demonstrated evolutionary ischemic changes. Coronary angiography revealed no abnormality of large vessels. These findings suggested small vascular lesions-induced myocardial ischemia was the underlying mechanism of dilated cardiomyopathy. As myocardial biopsy was not done in our case, we could only speculate, but not prove, that the NINV observed in renal biopsy may also involve in cardiac microvascular beds. Nevertheless, this interesting case emphasized the role of obliterative small vascular lesions in the pathophysiology of ARF and myocardial dysfunction. The patient was treated with high-dose corticosteroid, plasma infusion and hemodialysis. His cardiac function improved gradually, however the renal function did not recover.
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Affiliation(s)
- J M Sung
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, Republic of China.
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133
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Lin JJ, Hsu HB, Sun SS, Wang JJ, Ho ST, Kao CH. Single photon emission computed tomography of technetium-99m tetrofosmin myocardial perfusion imaging in patients with systemic lupus erythematosus--a preliminary report. JAPANESE HEART JOURNAL 2003; 44:83-9. [PMID: 12622440 DOI: 10.1536/jhj.44.83] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to evaluate the utility of single-photon emission computed tomography (SPECT) of technetium-99m tetrofosmin (Tc-99m TF) myocardial perfusion imaging to detect myocardial involvement in patients with systemic lupus erythematosus (SLE). Three groups of subjects-group 1: 25 SLE female patients with non-specific cardiac symptoms and signs, group 2: 25 female SLE patients without any cardiac symptoms and signs, and group 3: 25 female healthy controls-were evaluated by comparing rest and dipyridamole-stress Tc-99m TF myocardial perfusion SPECT. Tc-99m TF myocardial perfusion SPECT revealed perfusion defects in 88% and 40% of the cases in groups 1 and 2. respectively. However, no cases in group 3 demonstrated myocardial perfusion defects. Tc-99m TF myocardial perfusion SPECT is a useful noninvasive imaging modality to detect cardiac involvement in SLE patients with or without cardiac symptoms and signs.
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Affiliation(s)
- Jen-Jhy Lin
- Division of Cardiology, China Medical College Hospital, Taichung, Taiwan
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134
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Chockalingam A, Prabhakar D, Gnanavelu G, Chockalingam V. Pancarditis as initial presentation of systemic lupus erythematosus. Int J Cardiol 2003; 87:111-4. [PMID: 12468063 DOI: 10.1016/s0167-5273(02)00280-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Systemic lupus erythematosus (SLE) is a multisystem disorder with cardiac involvement in about 50% of cases, yet clinically significant lesions are less common. SLE with pancarditis at initial presentation has so far not been reported. We present a rare case of SLE with culture negative endocarditis, reversible left ventricular (LV) dysfunction and mild pericardial effusion. Treatment with steroids showed improvement in cardiac contractile function and mitral valve vegetations disappeared over 3 months. In a case of pancarditis with culture negative endocarditis, SLE as a possibility must be explored. After excluding infective endocarditis, a short trial of high dose corticosteroids effects overall improvement in carditis of SLE.
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135
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Abstract
SLE causes significant morbidity and mortality by multisystem organ involvement. Infections are the leading cause of morbidity and mortality in patients with SLE. Meticulous exclusion of infection is mandatory in patients with SLE, because infections may masquerade as exacerbation of underlying disease; and the immunosuppression used to treat severe forms of exacerbation of lupus can have catastrophic consequences in patients with infections. Corticosteroids are the first-line therapy for most noninfectious complications of SLE, with various adjuvant immunosuppressive agents such as cyclophosphamide being increasingly used in combination with plasmapheresis. Some recent series have shown an improved survival rate, but this improvement needs to be confirmed by further studies. Controlled trials comparing various therapeutic options are lacking, and optimal therapy has not been defined.
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Affiliation(s)
- Rishi Raj
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, Desk A-90, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Aoyagi S, Akashi H, Otsuka H, Sakashita H, Okazaki T, Tayama AKI. Acute type A aortic dissection in a patient with systemic lupus erythematosus. JAPANESE HEART JOURNAL 2002; 43:567-71. [PMID: 12452314 DOI: 10.1536/jhj.43.567] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The case of a 27-year-old Japanese woman with type A acute aortic dissection who had been diagnosed with systemic lupus erythematosus (SLE) is presented. The patient also had aortic regurgitation due to non-infective endocarditis and systemic hypertension, and had been maintained on steroid therapy for 15 years. Her twin sister was also diagnosed with SLE. The patient was admitted to emergency due to severe back pain. A chest x-ray showed enlargement of the upper mediastinum. Echocardiography revealed a thickened and deformed aortic valve with aortic regurgitation and dissection of the ascending aorta, but pericardial effusion was not found. Computed tomography demonstrated aortic dissection extending from the ascending aorta to the abdominal aorta. Graft replacement of the ascending aorta and proximal aortic arch was performed under hypothermic circulatory arrest with retrograde cerebral perfusion. The patient recovered uneventfully. Aortic dissection complicated with SLE is extremely rare, and this is only the 15th case reported in the English or Japanese literature.
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Affiliation(s)
- Shigeaki Aoyagi
- Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan
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137
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Abstract
Systemic lupus erythematosus (SLE) is a connective tissue disease characterized by the formation of autoantibodies and immune complexes. The heart and lungs are among the organ systems commonly affected in SLE. Pericarditis, premature coronary atherosclerosis, pleuritis and pulmonary infections are the most prevalent cardiopulmonary manifestations. Other rare associations include myocarditis, coronary arteritis, acute lupus pneumonitis/pulmonary haemorrhage, acute reversible hypoxaemia and 'shrinking lung' syndrome. Current imaging modalities may provide earlier detection of subclinical disease, which may aid in preventing these potentially fatal complications. The response to treatment varies, depending on the presentation of disease. In this chapter we address the frequency, diagnosis and monitoring, and treatment regimens of cardiac and pulmonary involvement in patients with SLE.
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Affiliation(s)
- Amy H Kao
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, PA 15261, USA
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138
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Sun SS, Shiau YC, Tsai SC, Lin CC, Kao A, Lee CC. The role of technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography (SPECT) in the detection of cardiovascular involvement in systemic lupus erythematosus patients with non-specific chest complaints. Rheumatology (Oxford) 2001; 40:1106-11. [PMID: 11600739 DOI: 10.1093/rheumatology/40.10.1106] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Systemic lupus erythematosus (SLE) can affect multiple organs. Coronary artery disease has received increasing recognition as a major cause of morbidity and mortality in SLE in recent years. The purpose of this study was to evaluate the utility of technetium-99m sestamibi single-photon emission computed tomography ((99m)Tc-sestamibi SPECT) in the detection of cardiovascular involvement in SLE patients with non-specific clinical chest symptoms such as chest discomfort and/or dyspnoea and/or occasional palpitation. METHODS Thirty-three SLE female patients (age range: 22-45 yr) with non-specific complaints such as chest discomfort and/or dyspnoea and/or occasional palpitation were investigated using a (99m)Tc-sestamibi myocardial perfusion SPECT scan at rest and after dipyridamole infusion in a stress study. The age- and sex-matched healthy group (24 cases) and SLE patients without any cardiovascular symptoms/signs (28 cases) were also included as controls in this study. The results of the uptake pattern of (99m)Tc-sestamibi were classified into four types including normal, persistent perfusion defect, reversible perfusion defect and reverse redistribution. RESULTS Perfusion abnormalities were detected in 27 cases (seven patients had persistent perfusion defects, 15 patients had reversible perfusion defects, one patient had both persistent and reversible perfusion defects, two patients showed a reverse redistribution pattern and two patients had both reversible perfusion defects and a reverse redistribution pattern). The results of the SPECT in the healthy group were all normal. However, perfusion abnormalities were detected in 12 cases in the group of asymptomatic SLE patients. CONCLUSIONS (99m)Tc-sestamibi myocardial perfusion SPECT is a useful non-invasive imaging modality to detect cardiovascular involvement in SLE patients with non-specific clinical complaints of heart disease.
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Affiliation(s)
- S S Sun
- Department of Nuclear Medicine, China Medicine College Hospital, Taichung, Taiwan
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139
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Abstract
OBJECTIVES It has been proposed that elevated blood viscosity contributes to atherothrombotic and thromboembolic processes. We evaluated whether there is increased blood viscosity in systemic lupus erythematosus (SLE) that might contribute to cardiovascular complications and reduced tissue perfusion. METHODS Blood viscosity profiles were evaluated in SLE patients to determine whether rheologic disturbances contribute to the cardiovascular risk profile. Blood viscosity profiles were evaluated in 27 patients with SLE and 46 age- and gender-matched controls. Blood viscosity was measured at 37 degrees C and shear rates of 1 s(-1) and 100 s(-1), then corrected to the average hematocrit of the SLE patients. RESULTS Corrected blood viscosity values were higher in SLE patients than in controls at 100 s(-1) (P =.002). Positive correlations were found between the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index for SLE, which quantifies damage to 12 organ systems and fibrinogen (rho =.39; P =.042) and plasma viscosity (rho =.38; P =.049). CONCLUSIONS Our data indicate that blood viscosity values at a standard hematocrit are elevated in SLE patients. Further investigations are needed to evaluate whether the increased blood viscosity values in SLE patients contribute to cardiovascular complications and tissue ischemia. CLINICAL RELEVANCE Because blood viscosity values correlate with the clinical severity of SLE, blood viscosity may contribute to the cardiovascular complications and reduced tissue perfusion in SLE patients. Semin Arthritis Rheum 31:52-57.
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Affiliation(s)
- R S Rosenson
- Preventive Cardiology Center, Northwestern University Medical School, Chicago, IL 60611, USA.
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140
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Karrar A, Sequeira W, Block JA. Coronary artery disease in systemic lupus erythematosus: A review of the literature. Semin Arthritis Rheum 2001; 30:436-43. [PMID: 11404827 DOI: 10.1053/sarh.2001.23498] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
CONTEXT Coronary artery occlusive disease is a common though underappreciated complication of systemic lupus erythematosus (SLE), typically a disease of young women. A case of a premenopausal patient with SLE and an acute myocardial infarction is presented, and the etiology and management of coronary artery disease in SLE reviewed. OBJECTIVES To review the incidence, risk factors, pathology and treatment of coronary artery disease in systemic lupus erythematosus. DATA SOURCES MEDLINE search of articles in English-language journals from 1980 to 2000. The index words "systemic lupus erythematosus" and the following co-indexing terms were used: "coronary artery disease," "atherosclerosis," "vasculitis," "anticardiolipin antibodies," "antiphospholipid syndrome." SELECTION SYNTHESIS AND ABSTRACTION: Papers identified were reviewed and abstracted by the authors with a presentation of a summary. RESULTS The prevalence of coronary artery disease among women with SLE between the ages of 35 and 44 years is at least 50-fold greater than among age-matched control subjects. Of these, coronary atherosclerosis accounts for the vast majority of cases; vasculitis of the coronary arteries and other causes generally believed to be more typical of SLE are comparatively rare. CONCLUSIONS The evidence suggests that SLE is a significant risk factor for coronary atherosclerosis independent of the classic risk factors of hypertension, tobacco use, and hyperlipidemia.
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Affiliation(s)
- A Karrar
- Rush-Presbyterian-St. Luke's Medical Center and Cook County Hospital, Chicago IL, USA
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141
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Nose M, Nishihara M, Fujii H. Genetic basis of the complex pathological manifestations of collagen disease: lessons from MRL/lpr and related mouse models. Int Rev Immunol 2001; 19:473-98. [PMID: 11016428 DOI: 10.3109/08830180009055508] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The pathological findings in collagen disease including systemic lupus erythematosus show complex lesions such as glomerulonephritis, systemic vasculitis, polyarthritis, sialoadenitis, etc. Moreover, some cases of collagen disease are categorized into overlapping syndromes. It is still controversial whether such diversity and similarity of pathological manifestations among the collagen disease depends on ambiguity in diagnosis or is an intrinsic quality of the collagen diseases themselves. In this paper, we reviewed this subject focusing on a series of our genetic studies of murine models of collagen disease, MRL strains of mice with a deficit in Fas-mediated apoptosis, which spontaneously develop glomerulonephritis, systemic vasculitis, polyarthritis and sialoadenitis. We observed that each lesion was controlled by a different set of genes and they appeared to act in an additive manner on the development of each lesion. We conclude that various disease categories in collagen disease will be a result of the combination of polygenes.
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Affiliation(s)
- M Nose
- Department of Pathology, Ehime University School of Medicine, Shigenobu, Japan
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142
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Wolak T, Abu-Shakra M, Flusser D, Liel-Cohen N, Buskila D, Sukenik S. Kingella endocarditis and meningitis in a patient with SLE and associated antiphospholipid syndrome. Lupus 2000; 9:393-6. [PMID: 10878736 DOI: 10.1191/096120300678828389] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe a patient with SLE and antiphospholipid syndrome who presented with severe headache and fever. Lumbar puncture analyses indicated meningitis. Kingella kingae was isolated from her blood cultures. A large mobile vegetation was seen on her mitral valve. The association between SLE, Libman-Sacks endocarditis and bacterial endocarditis is discussed.
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Affiliation(s)
- T Wolak
- Department of Medicine D, Soroka Medical Center and Ben-Gurion University, Beer-Sheva, Israel
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143
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Abstract
Many patients with systemic lupus erythematosus (SLE) develop cardiac manifestations during the course of their disease. Pericarditis is most commonly seen, with a reported prevalence of 60%. Myocardial involvement is present in only a minority of patients. In recent years, due to better noninvasive diagnostic techniques, valvular abnormalities can be demonstrated in an increasing number of patients. Depending on the technique used, valvulopathy can be demonstrated in up to 77% of SLE patients. Although most of the valvular lesions will be present without any symptoms, valve incompetence can result in congestive heart failure. Valvular lesions are associated with IgG anticardiolipin antibodies (aCL) and disease duration. We present a patient with SLE and secondary antiphospholipid syndrome (APS) who developed acute congestive heart failure due to pancarditis. Endocarditis, together with left ventricular dysfunction and pericardial effusion, were present. The endocarditis caused hemodynamically significant mitral valve insufficiency due to thickening of the mitral cusps. Just two weeks prior to the occurrence of congestive heart failure echocardiography had been normal. Treatment with high dose corticosteroids resulted in a gradual, almost complete recovery. Literature concerning cardiac manifestations in lupus is reviewed.
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Affiliation(s)
- M Bijl
- Department of Internal Medicine, University Hospital, Groningen, The Netherlands.
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144
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Nishinarita M, Nakagawa M, Tanaka E. Dilated cardiomyopathy (DCM) associated with SSA antibody in primary Sjögren syndrome. Mod Rheumatol 2000; 10:114-6. [PMID: 24383566 DOI: 10.3109/s101650050009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract A 33-year-old Japanese woman was diagnosed with primary Sjögren syndrome (SS) in 1995. At this time, SSA antibody had not been detected by the Oucterlony or EIA methods. Two years later, the patient developed dyspnea. A chest X-ray showed cardiomegaly. An echocardiogram indicated severe diffuse hypokynesis of the cardiac wall with a left ventricular ejection fraction of 32%. Positive SSA antibody (over 500 u/ml) was noted in her serum as measured by the EIA method. We considered her cardiac manifestation to be dilated cardiomyopathy associated with primary SS.
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Affiliation(s)
- M Nishinarita
- Department of Rheumatology, Taga General Hospital , 2-1-2 Kokubu-cho, Hitachi 316-0035 , Japan
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145
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Ohara N, Miyata T, Kurata A, Oshiro H, Sato O, Shigematsu H. Ten years' experience of aortic aneurysm associated with systemic lupus erythematosus. Eur J Vasc Endovasc Surg 2000; 19:288-93. [PMID: 10753693 DOI: 10.1053/ejvs.1999.0982] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND aortic aneurysm is a rare but life-threatening cardiovascular complication in patients with systemic lupus erythematosus (SLE). The purpose of this study was to clarify the characteristic clinical features and the pathological mechanism of aneurysmal formation in these patients. METHODS among 429 patients operated on for abdominal aortic aneurysm (AAA) during the past 10 years, five cases with SLE were treated surgically. Their clinical data were reviewed, and the resected aneurysmal wall of the five patients was also examined histologically. RESULTS the mean age of the patients with SLE was 55 years, which was statistically younger than that of the other patients (mean 77 years, s.d. 7.9, p <0.05). They had received long-term corticosteroid therapy for the treatment of SLE for a mean of 23 years. Histologically, destruction of the medial elastic lamina was characteristic. Four patients had no complications in the postoperative follow-up period (mean 4 years), while the remaining patient died of rupture of a dissecting aneurysm two years after operation. CONCLUSION prolonged steroid therapy may play a major role in accelerating atherosclerosis, which can result in aortic aneurysmal enlargement, possibly together with primary aortic wall involvement and/or vasculitic damage in patients with SLE.
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Affiliation(s)
- N Ohara
- Division of Vascular Surgery, Department of Surgery, Japan
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146
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Ueda T, Mizushige K, Aoyama T, Tokuda M, Kiyomoto H, Matsuo H. Echocardiographic observation of acute myocarditis with systemic lupus erythematosus. JAPANESE CIRCULATION JOURNAL 2000; 64:144-6. [PMID: 10716530 DOI: 10.1253/jcj.64.144] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although myocarditis from a series of autopsies of patients with systemic lupus erythematosus was frequently observed, the incidence of clinically apparent myocardial dysfunction was low. A 30-year-old woman with systemic lupus erythematosus was examined by echocardiography. An acoustic densitometry was followed at the left ventricular posterior wall throughout the clinical course. A decrease in the magnitude of cyclic variation of integrated backscatter (IB) was observed before treatment. Following the combined treatment, steroid and cyclophosphamide, a repeated ultrasonic tissue characterization showed an increase in the magnitude of cyclic variation of IB. It is thought that ultrasonic tissue characterization may be a useful method to evaluate the impairment of contraction, and to follow up the clinical course of myocardial involvement in systemic lupus erythematosus.
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Affiliation(s)
- T Ueda
- Second Department of Internal Medicine, Kagawa Medical University, Japan
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147
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Wang J, French SW, Chuang CC, McPhaul L. Pathologic quiz case: an unusual complication of systemic lupus erythematosus. Arch Pathol Lab Med 2000; 124:324-6. [PMID: 10656751 DOI: 10.5858/2000-124-0324-pqc] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- J Wang
- Department of Pathology, Harbor-UCLA Medical Center, Torrance, Calif, USA
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148
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Hort W, Schwartzkopff B. Anatomie und Pathologie der Koronararterien. PATHOLOGIE DES ENDOKARD, DER KRANZARTERIEN UND DES MYOKARD 2000. [DOI: 10.1007/978-3-642-56944-9_3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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149
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Ura M, Sakata R, Nakayama Y, Ohtsuka Y, Saito T. Coronary artery bypass grafting in patients with systemic lupus erythematosus. Eur J Cardiothorac Surg 1999; 15:697-701. [PMID: 10386420 DOI: 10.1016/s1010-7940(99)00064-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Few reports exist on the results of coronary artery bypass grafting (CABG) in patients with systemic lupus erythematosus (SLE). METHODS We retrospectively reviewed eight CABG in seven SLE patients. In early and late postoperative angiography, all grafts were evaluated for occlusion, development of string sign, or presence of significant stenosis. The early and late results were compared. The pathological studies were performed on the segments of the internal thoracic artery (ITA) and saphenous vein collected from each patient. Atherosclerosis of the ITA was analyzed using the subjective evaluation proposed by Kay et al. (Kay HR, Korns ME, Flemma RJ, Tector AJ, Lepley D. Atherosclerosis of the internal mammary artery. Ann Thorac Surg 21;1976:504-507) scale 0-4 (0 = normal, 1 = minimal disease, 2 = less than 25% luminal narrowing, 3 = 25-50% narrowing, and 4 = greater than 50% narrowing). RESULTS The patients consisted of three men and four women with a mean age of 59.8 years. Co-morbid diseases were frequent and there were three patients (37.5%) with renal failure (two dialysis patients, one with renal dysfunction) and two patients with severe atherosclerosis of the aorta. The ITA was used in four patients. Saphenous vein graft was used in seven patients. Concomitant procedures included aortic valve replacement and mitral annuloplasty, mitral valvuloplasty and tricuspid annuloplasty, mitral valve replacement and tricuspid annuloplasty (TAP). There was one hospital death (12.5%). Early patency rates were 87.5% (21/24). No other atherosclerotic changes or stenosis suggesting vasculitis were noted. In pathological studies, there was no significant atherosclerosis in the six ITA specimens from four patients, although three patients had degree two atherosclerosis. No vasculitis was found in ITA or saphenous vein grafts. During the mean follow-up period of 35.3 months (range, 5-91 months), there was one non-cardiac late death. Late restudy (in three patients, 12, 57 and 64 months later respectively) revealed no deterioration in either ITA or vein grafts. Overall prognosis after the operation in SLE patients appears to be good. No other cardiac events were observed, and patients demonstrated marked clinical improvement. CONCLUSIONS CABG in SLE patients can be performed with acceptable morbidity and mortality. Our data so far reveals no evidence to preclude the use of ITA and vein grafts in SLE patients.
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Affiliation(s)
- M Ura
- Department of Cardiovascular Surgery, Kumamoto Central Hospital, Japan
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150
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Abstract
Systemic lupus erythematosus (SLE), a connective tissue disease characterized by the production of autoantibodies, can affect all organ systems. Cardiac involvement in patients with SLE has been described since the early 20th century. The manifestations are numerous and can involve all components of the heart, including the pericardium, conduction system, myocardium, valves, and coronary arteries. In recent years, echocardiography has yielded additional information about the heart in patients who have SLE with and without clinical cardiac involvement. Moreover, antiphospholipid antibodies have been linked to several cardiac manifestations in patients with SLE, including valvular abnormalities and possibly coronary artery disease. This updated, comprehensive review summarizes the new literature on SLE and the heart.
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Affiliation(s)
- K G Moder
- Division of Rheumatology and Internal Medicine, Mayo Clinic Rochester, MN 55905, USA
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