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Agha HM, Othman MA, El-Saiedi S, El Zahrae Hassan F, Taher H, El-Sisi A, Sobhy R, AbdelMassih A. Early onset left ventricular remodeling in juvenile systemic lupus erythematosus; Insight from 3-dimensional speckle tracking echocardiography. Lupus 2021; 30:2114-2123. [PMID: 34794349 DOI: 10.1177/09612033211051302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Early diagnosis and treatment of myocardial affection in patients with systemic lupus erythematosus (SLE) are crucial. OBJECTIVES To evaluate the ventricular systolic function in juvenile-onset systemic lupus erythematosus (j-SLE) patients by 3-D speckle tracking echocardiography (3D-STE) and to determine the predictors of left ventricular (LV) dysfunction if present. METHODS Twenty-six SLE patients without heart failure and 21 healthy controls were studied by standard echocardiogram and 3D-STE. Conventional parameters included LV ejection fraction (EF), fractional shortening (FS), and mitral annular plane systolic excursion (MAPSE). Global LV strain (GLS) and global area strain (GAS) were obtained by 3D-STE. Medical records, including diagnosis criteria, duration of disease, and SLE disease activity index (SLEDAI) were evaluated. RESULTS The mean age was similar in patients and controls 11.42 vs 11.48 years p = 0.93. The mean duration of the disease was 1.87 ± 1.02 years and SLEDAI ranged from 0 to 9. By conventional and tissue Doppler imaging echocardiography, only MAPSE was significantly lower in SLE patients compared to controls (14.56 vs 18.46 mm, p < 0.001). By 3D speckle tracking echocardiography, GLS and GAS were significantly reduced in SLE patients compared to controls (-15.07 vs -19.9.4%, -34.6% vs -39.7%, respectively, p < 0.001). Multiple linear regression and ROC analyses indicated that the SLEDAI score was the only predictive factor for the left ventricular remodeling. CONCLUSIONS These results indicate that early subclinical LV dysfunction occur in jSLE patients even with normal EF and SLE disease activity might be a potential driver for LV deformation.
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Affiliation(s)
- Hala M Agha
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, 63527Cairo University, Cairo, Egypt
| | - Mahmoud A Othman
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, 63527Cairo University, Cairo, Egypt
| | - Sonia El-Saiedi
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, 63527Cairo University, Cairo, Egypt
| | - Fatma El Zahrae Hassan
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, 63527Cairo University, Cairo, Egypt
| | - Heba Taher
- Department of Pediatrics, Pediatric Rheumatology Unit, Specialized Pediatric Hospital, 63527Cairo University, Cairo, Egypt
| | - Amal El-Sisi
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, 63527Cairo University, Cairo, Egypt
| | - Rodina Sobhy
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, 63527Cairo University, Cairo, Egypt
| | - Antoine AbdelMassih
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, 63527Cairo University, Cairo, Egypt
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Mishra AK, Sahu KK, Nagabandi S, Benotti J. Infective endocarditis with mitral leaflet perforation and multiple embolic infarcts. QJM 2020; 113:757-759. [PMID: 32061127 DOI: 10.1093/qjmed/hcaa026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A K Mishra
- Internal Medicine, St. Vincent Hospital, 123 Summer Street, Worcester, MA, USA
| | - K K Sahu
- Internal Medicine, St. Vincent Hospital, 123 Summer Street, Worcester, MA, USA
| | - S Nagabandi
- Department of Cardiology, St. Vincent Hospital, 123 Summer Street, Worcester, MA, USA
| | - J Benotti
- Department of Cardiology, St. Vincent Hospital, 123 Summer Street, Worcester, MA, USA
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Curtis E, Corkill M, Amir N, Haydock D. Acute papillary muscle infarction and rupture in the puerperium complicating Libman-Sacks endocarditis in a patient with systemic lupus erythematosus and antiphospholipid syndrome: a case report. Eur Heart J Case Rep 2019; 3:1-4. [PMID: 32099964 PMCID: PMC7026610 DOI: 10.1093/ehjcr/ytz163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/09/2019] [Accepted: 09/04/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Acute heart failure caused by severe mitral regurgitation (MR) due to papillary muscle rupture has been described in the puerperium by case reports; however, the majority of cases of papillary muscle rupture are caused by myocardial infarction. We describe papillary muscle rupture occurring in the postpartum period in a patient with systemic lupus erythematosus (SLE), antiphospholipid syndrome (APLS), and chronic Libman-Sacks endocarditis and explore the multifactorial nature of the papillary muscle infarction and rupture in the setting of postpartum fluid shifts, chronic myocardial injury from Libman-Sacks, and high thrombotic risk. CASE SUMMARY A 29-year-old woman presented with acute heart failure 2 weeks' postpartum and was found to have acute MR due to a flail leaflet caused by papillary muscle rupture. She proceeded to emergency surgery with mitral valve (MV) replacement and the histology revealed evidence of chronic Libman-Sacks endocarditis and papillary muscle infarction with thrombi in the intramyocardial arteries. DISCUSSION This is the second case report of papillary muscle rupture in the puerperium in a patient with SLE in the literature, the other case was caused by catastrophic APLS. However, in this case, the cause of the rupture is likely to be multifactorial; as a consequence of thrombosis in the microvasculature causing isolated papillary muscle ischaemia, and fibrosis of the muscle due to chronic Libman-Sacks endocarditis resulting in limited pliability which caused rupture of the papillary muscle when faced with the added stress of increased volume that occurs in the puerperium.
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Affiliation(s)
- Elizabeth Curtis
- Cardiology Department, North Shore Hospital, Waitemata District Healthboard, 124 Shakespeare Rd, Takapuna, Auckland 0620, New Zealand
| | - Michael Corkill
- Cardiology Department, North Shore Hospital, Waitemata District Healthboard, 124 Shakespeare Rd, Takapuna, Auckland 0620, New Zealand
| | - Nezar Amir
- Cardiology Department, North Shore Hospital, Waitemata District Healthboard, 124 Shakespeare Rd, Takapuna, Auckland 0620, New Zealand
| | - David Haydock
- Cardiothoracic Surgery, Auckland City Hospital, Auckland District Healthboard, 2 Park Rd, Grafton, Auckland 1023, New Zealand
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Watad A, Tiosano S, Grysman N, Comaneshter D, Cohen AD, Shoenfeld Y, Amital H. The association between systemic lupus erythematosus and valvular heart disease: an extensive data analysis. Eur J Clin Invest 2017; 47:366-371. [PMID: 28295225 DOI: 10.1111/eci.12744] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 03/06/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Association between antiphospholipid syndrome in systemic lupus erythematosus (SLE) and valvular heart disease (VHD) is well reported, but relatively few studies have been carried out to establish the linkage between VHD and SLE itself. We aimed to investigate link between VHD and SLE and to evaluate the association of diverse factors with VHD among these patients in a large-scale population-based study. MATERIALS AND METHODS We used the databases of the largest state-mandated health service organization in Israel. All SLE patients were included (n = 5018) as well as their age and sex-matched controls (n = 25 090), creating a cross-sectional population-based study. Medical records of all subjects were analysed for documented VHD and the presence of antiphospholipid antibodies (aPLs). A logistic regression model was carried out to evaluate the diverse factors including SLE and aPLs as independent risk factors for VHD. RESULTS Valvular heart disease were found to be more frequent among SLE group when compared to controls (aortic stenosis, 1·08% vs. 0·35% respectively, P < 0·001; aortic insufficiency, 1·32% vs. 0·29% respectively, P < 0·001; mitral stenosis, 0·74% vs. 0·21% respectively, P < 0·001; mitral insufficiency, 1·91% vs. 0·39% respectively, P < 0·001). Male sex, hypertension, aPLs and SLE were found to be significant independent risk factors for VHD. CONCLUSION All VHD are more prevalent among SLE patients when compared to controls. SLE and aPLs are independent risk factor for VHD (OR of 2·46 and 1·7, respectively). Physicians must be aware of such significant association, and routine echocardiography should be considered in SLE patients regardless of their aPL status.
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Affiliation(s)
- Abdulla Watad
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shmuel Tiosano
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Noam Grysman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Arnon D Cohen
- Chief Physician's Office, Clalit Health Services, Tel-Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Howard Amital
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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