Skip to main content
Top
Published in: Clinical Rheumatology 2/2011

01-02-2011 | Review Article

Association of antiphospholipid antibodies with valvulopathy in systemic lupus erythematosus: a systematic review

Authors: Priscila Mattos, Mittermayer B. Santiago

Published in: Clinical Rheumatology | Issue 2/2011

Login to get access

Abstract

Over the last few years, several studies in patients with systemic lupus erythematosus (SLE) have demonstrated an association between valvulopathy, including Libman–Sacks endocarditis (LS) and the presence of antiphospholipid antibodies (aPL), suggesting a role of these antibodies in the pathogenesis of the lesions. On the other hand, other studies found no such association. The aim of the present study is to analyze, by means of a systematic review, the existent evidences about the association between aPL and valvular lesions, including LS endocarditis, in patients with SLE. The information was obtained through searches for articles in the MEDLINE (1966 to 2010), SciELO, and LILACS databases, using the following key words: “Libman–Sacks endocarditis”, “antiphospholipid and Libman–Sacks”, “antiphospholipid and valvular heart disease”, “antiphospholipid and verrucous endocarditis”, “antiphospholipid and heart”, “antiphospholipid and valvular vegetations”, “anticardiolipin antibodies” and the corresponding translations in Portuguese. Twenty articles were found, which evaluated the association between the presence of aPL and valvulopathy. Thirteen of these studies evaluated the association of aPL with the LS lesion. Of the 20 articles, 15 demonstrated a positive association between aPL and valvular lesions, whereas 5 articles demonstrated that there was no association. Evidence of an association between the presence of aPL and valvular lesion was demonstrated in the majority of studies. Nevertheless, the possible role of these antibodies in the etiopathogenesis of the lesion has not yet been proved.
Literature
1.
go back to reference Asherson RA, Hughes GR (1989) The expanding spectrum of Libman Sacks endocarditis: the role of antiphospholipid antibodies. Clin Exp Rheumatol 7(3):225–228PubMed Asherson RA, Hughes GR (1989) The expanding spectrum of Libman Sacks endocarditis: the role of antiphospholipid antibodies. Clin Exp Rheumatol 7(3):225–228PubMed
2.
go back to reference Galli M, Comfurius P, Maassen C, Hemker HC, de Baets MH, van Breda-Vriesman PJ et al (1990) Anticardiolipin antibodies (ACA) directed not to cardiolipin but to a plasma protein cofactor. Lancet 335(8705):1544–1547CrossRefPubMed Galli M, Comfurius P, Maassen C, Hemker HC, de Baets MH, van Breda-Vriesman PJ et al (1990) Anticardiolipin antibodies (ACA) directed not to cardiolipin but to a plasma protein cofactor. Lancet 335(8705):1544–1547CrossRefPubMed
3.
go back to reference Hughes GR, Harris NN, Gharavi AE (1986) The anticardiolipin syndrome. J Rheumatol 13(3):486–489PubMed Hughes GR, Harris NN, Gharavi AE (1986) The anticardiolipin syndrome. J Rheumatol 13(3):486–489PubMed
5.
go back to reference Asherson RA, Cervera R (2003) Unusual manifestations of the antiphospholipid syndrome. Clin Rev Allergy Immunol 25(1):61–78CrossRefPubMed Asherson RA, Cervera R (2003) Unusual manifestations of the antiphospholipid syndrome. Clin Rev Allergy Immunol 25(1):61–78CrossRefPubMed
6.
go back to reference Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT et al (2002) Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1, 000 patients. Arthritis Rheum 46(4):1019–1027CrossRefPubMed Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT et al (2002) Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1, 000 patients. Arthritis Rheum 46(4):1019–1027CrossRefPubMed
7.
go back to reference Amoroso A, Cacciapaglia F, De CS, Battagliese A, Coppolino G, Galluzzo S et al (2006) The adjunctive role of antiphospholipid antibodies in systemic lupus erythematosus cardiac involvement. Clin Exp Rheumatol 24(3):287–294PubMed Amoroso A, Cacciapaglia F, De CS, Battagliese A, Coppolino G, Galluzzo S et al (2006) The adjunctive role of antiphospholipid antibodies in systemic lupus erythematosus cardiac involvement. Clin Exp Rheumatol 24(3):287–294PubMed
8.
go back to reference Diaz RA, Athanassopoulos G, Nihoyannopoulos P (1993) Systemic lupus erythematosus: valvular regurgitation and its relation to anticardiolipin antibodies. Rev Med Chil 121(2):156–161PubMed Diaz RA, Athanassopoulos G, Nihoyannopoulos P (1993) Systemic lupus erythematosus: valvular regurgitation and its relation to anticardiolipin antibodies. Rev Med Chil 121(2):156–161PubMed
9.
go back to reference Farzaneh-Far A, Roman MJ, Lockshin MD, Devereux RB, Paget SA, Crow MK et al (2006) Relationship of antiphospholipid antibodies to cardiovascular manifestations of systemic lupus erythematosus. Arthritis Rheum 54(12):3918–3925CrossRefPubMed Farzaneh-Far A, Roman MJ, Lockshin MD, Devereux RB, Paget SA, Crow MK et al (2006) Relationship of antiphospholipid antibodies to cardiovascular manifestations of systemic lupus erythematosus. Arthritis Rheum 54(12):3918–3925CrossRefPubMed
10.
go back to reference Khamashta MA, Cervera R, Asherson RA, Font J, Gil A, Coltart DJ et al (1990) Association of antibodies against phospholipids with heart valve disease in systemic lupus erythematosus. Lancet 335(8705):1541–1544CrossRefPubMed Khamashta MA, Cervera R, Asherson RA, Font J, Gil A, Coltart DJ et al (1990) Association of antibodies against phospholipids with heart valve disease in systemic lupus erythematosus. Lancet 335(8705):1541–1544CrossRefPubMed
11.
go back to reference Lolli C, Foscoli M, Giofre R, Tarquinii M, Pasquali S, Toschi GP (1993) Cardiac anomalies in systemic lupus erythematosus: their prevalence and relation to duration, disease activity and the presence of antiphospholipid antibodies. G Ital Cardiol 23(11):1125–1134PubMed Lolli C, Foscoli M, Giofre R, Tarquinii M, Pasquali S, Toschi GP (1993) Cardiac anomalies in systemic lupus erythematosus: their prevalence and relation to duration, disease activity and the presence of antiphospholipid antibodies. G Ital Cardiol 23(11):1125–1134PubMed
12.
go back to reference Moyssakis I, Tektonidou MG, Vasilliou VA, Samarkos M, Votteas V, Moutsopoulos HM (2007) Libman-Sacks endocarditis in systemic lupus erythematosus: prevalence, associations, and evolution. Am J Med 120(7):636–642CrossRefPubMed Moyssakis I, Tektonidou MG, Vasilliou VA, Samarkos M, Votteas V, Moutsopoulos HM (2007) Libman-Sacks endocarditis in systemic lupus erythematosus: prevalence, associations, and evolution. Am J Med 120(7):636–642CrossRefPubMed
13.
go back to reference Nihoyannopoulos P, Gomez PM, Joshi J, Loizou S, Walport MJ, Oakley CM (1990) Cardiac abnormalities in systemic lupus erythematosus. association with raised anticardiolipin antibodies. Circulation 82(2):369–375PubMed Nihoyannopoulos P, Gomez PM, Joshi J, Loizou S, Walport MJ, Oakley CM (1990) Cardiac abnormalities in systemic lupus erythematosus. association with raised anticardiolipin antibodies. Circulation 82(2):369–375PubMed
14.
go back to reference Perez-Villa F, Font J, Azqueta M, Espinosa G, Pare C, Cervera R et al (2005) Severe valvular regurgitation and antiphospholipid antibodies in systemic lupus erythematosus: a prospective, long-term, followup study. Arthritis Rheum 53(3):460–467CrossRefPubMed Perez-Villa F, Font J, Azqueta M, Espinosa G, Pare C, Cervera R et al (2005) Severe valvular regurgitation and antiphospholipid antibodies in systemic lupus erythematosus: a prospective, long-term, followup study. Arthritis Rheum 53(3):460–467CrossRefPubMed
15.
go back to reference Cervera R, Font J, Pare C, Azqueta M, Perez-Villa F, Lopez-Soto A et al (1992) Cardiac disease in systemic lupus erythematosus: prospective study of 70 patients. Ann Rheum Dis 51(2):156–159CrossRefPubMed Cervera R, Font J, Pare C, Azqueta M, Perez-Villa F, Lopez-Soto A et al (1992) Cardiac disease in systemic lupus erythematosus: prospective study of 70 patients. Ann Rheum Dis 51(2):156–159CrossRefPubMed
16.
go back to reference Metz D, Jolly D, Graciet-Richard J, Nazeyrollas P, Chabert JP, Maillier B et al (1994) Prevalence of valvular involvement in systemic lupus erythematosus and association with antiphospholipid syndrome: a matched echocardiographic study. Cardiology 85(2):129–136CrossRefPubMed Metz D, Jolly D, Graciet-Richard J, Nazeyrollas P, Chabert JP, Maillier B et al (1994) Prevalence of valvular involvement in systemic lupus erythematosus and association with antiphospholipid syndrome: a matched echocardiographic study. Cardiology 85(2):129–136CrossRefPubMed
17.
go back to reference Jouhikainen T, Pohjola-Sintonen S, Stephansson E (1994) Lupus anticoagulant and cardiac manifestations in systemic lupus erythematosus. Lupus 3(3):167–172CrossRefPubMed Jouhikainen T, Pohjola-Sintonen S, Stephansson E (1994) Lupus anticoagulant and cardiac manifestations in systemic lupus erythematosus. Lupus 3(3):167–172CrossRefPubMed
18.
go back to reference Leung WH, Wong KL, Lau CP, Wong CK, Liu HW (1990) Association between antiphospholipid antibodies and cardiac abnormalities in patients with systemic lupus erythematosus. Am J Med 89(4):411–419CrossRefPubMed Leung WH, Wong KL, Lau CP, Wong CK, Liu HW (1990) Association between antiphospholipid antibodies and cardiac abnormalities in patients with systemic lupus erythematosus. Am J Med 89(4):411–419CrossRefPubMed
19.
go back to reference Sturfelt G, Eskilsson J, Nived O, Truedsson L, Valind S (1992) Cardiovascular disease in systemic lupus erythematosus. a study of 75 patients form a defined population. Med Baltim 71(4):216–223 Sturfelt G, Eskilsson J, Nived O, Truedsson L, Valind S (1992) Cardiovascular disease in systemic lupus erythematosus. a study of 75 patients form a defined population. Med Baltim 71(4):216–223
20.
go back to reference Giunta A, Picillo U, Maione S, Migliaresi S, Valentini G, Arnese M et al (1993) Spectrum of cardiac involvement in systemic lupus erythematosus: echocardiographic, echo-Doppler observations and immunological investigation. Acta Cardiol 48(2):183–197PubMed Giunta A, Picillo U, Maione S, Migliaresi S, Valentini G, Arnese M et al (1993) Spectrum of cardiac involvement in systemic lupus erythematosus: echocardiographic, echo-Doppler observations and immunological investigation. Acta Cardiol 48(2):183–197PubMed
21.
go back to reference Leszczynski P, Straburzynska-Migaj E, Korczowska I, Lacki JK, Mackiewicz S (2003) Cardiac valvular disease in patients with systemic lupus erythematosus. relationship with anticardiolipin antibodies. Clin Rheumatol 22(6):405–408CrossRefPubMed Leszczynski P, Straburzynska-Migaj E, Korczowska I, Lacki JK, Mackiewicz S (2003) Cardiac valvular disease in patients with systemic lupus erythematosus. relationship with anticardiolipin antibodies. Clin Rheumatol 22(6):405–408CrossRefPubMed
22.
go back to reference Gabrielli F, Alcini E, Di Prima MA, Mazzacurati G, Masala C (1995) Cardiac valve involvement in systemic lupus erythematosus and primary antiphospholipid syndrome: lack of correlation with antiphospholipid antibodies. Int J Cardiol 51(2):117–126CrossRefPubMed Gabrielli F, Alcini E, Di Prima MA, Mazzacurati G, Masala C (1995) Cardiac valve involvement in systemic lupus erythematosus and primary antiphospholipid syndrome: lack of correlation with antiphospholipid antibodies. Int J Cardiol 51(2):117–126CrossRefPubMed
23.
go back to reference Gleason CB, Stoddard MF, Wagner SG, Longaker RA, Pierangeli S, Harris EN (1993) A comparison of cardiac valvular involvement in the primary antiphospholipid syndrome versus anticardiolipin-negative systemic lupus erythematosus. Am Heart J 125(4):1123–1129CrossRefPubMed Gleason CB, Stoddard MF, Wagner SG, Longaker RA, Pierangeli S, Harris EN (1993) A comparison of cardiac valvular involvement in the primary antiphospholipid syndrome versus anticardiolipin-negative systemic lupus erythematosus. Am Heart J 125(4):1123–1129CrossRefPubMed
24.
go back to reference Ramonda R, Doria A, Villanova C, Vaccaro E, Punzi L, Fasoli G et al (1992) Evaluation of cardiac involvement in systemic lupus erythematosus. clinical and echographic study. Rev Rhum Mal OsteÂo Artic 59(12):790–796 Ramonda R, Doria A, Villanova C, Vaccaro E, Punzi L, Fasoli G et al (1992) Evaluation of cardiac involvement in systemic lupus erythematosus. clinical and echographic study. Rev Rhum Mal OsteÂo Artic 59(12):790–796
25.
go back to reference Roldan CA, Shively BK, Lau CC, Gurule FT, Smith EA, Crawford MH (1992) Systemic lupus erythematosus valve disease by transesophageal echocardiography and the role of antiphospholipid antibodies. J Am Coll Cardiol 20(5):1127–1134CrossRefPubMed Roldan CA, Shively BK, Lau CC, Gurule FT, Smith EA, Crawford MH (1992) Systemic lupus erythematosus valve disease by transesophageal echocardiography and the role of antiphospholipid antibodies. J Am Coll Cardiol 20(5):1127–1134CrossRefPubMed
26.
go back to reference Alves LJ, Hydalgo L, Rolim LF, Campagnone GZ, Aidar MT, Novaes GS et al (1997) Clinical and laboratory diagnosis of heart disease in systemic lupus erythematosus. Arq Bras Cardiol 68(2):79–83PubMed Alves LJ, Hydalgo L, Rolim LF, Campagnone GZ, Aidar MT, Novaes GS et al (1997) Clinical and laboratory diagnosis of heart disease in systemic lupus erythematosus. Arq Bras Cardiol 68(2):79–83PubMed
27.
go back to reference Hojnik M, George J, Ziporen L, Shoenfeld Y (1996) Heart valve involvement (Libman-Sacks endocarditis) in the antiphospholipid syndrome. Circulation 93(8):1579–1587PubMed Hojnik M, George J, Ziporen L, Shoenfeld Y (1996) Heart valve involvement (Libman-Sacks endocarditis) in the antiphospholipid syndrome. Circulation 93(8):1579–1587PubMed
28.
go back to reference Lee JL, Naguwa SM, Cheema GS, Gershwin ME (2009) Revisiting Libman–Sacks endocarditis: a historical review and update. Clin Rev Allergy Immunol 36(2–3):126–130CrossRefPubMed Lee JL, Naguwa SM, Cheema GS, Gershwin ME (2009) Revisiting Libman–Sacks endocarditis: a historical review and update. Clin Rev Allergy Immunol 36(2–3):126–130CrossRefPubMed
29.
go back to reference Menard GE (2008) Establishing the diagnosis of Libman–Sacks endocarditis in systemic lupus erythematosus. J Gen Intern Med 23(6):883–886CrossRefPubMed Menard GE (2008) Establishing the diagnosis of Libman–Sacks endocarditis in systemic lupus erythematosus. J Gen Intern Med 23(6):883–886CrossRefPubMed
30.
go back to reference Soltesz P, Szekanecz Z, Kiss E, Shoenfeld Y (2007) Cardiac manifestations in antiphospholipid syndrome. Autoimmun Rev 6(6):379–386CrossRefPubMed Soltesz P, Szekanecz Z, Kiss E, Shoenfeld Y (2007) Cardiac manifestations in antiphospholipid syndrome. Autoimmun Rev 6(6):379–386CrossRefPubMed
31.
go back to reference Asherson RA, Cervera R (1991) Antiphospholipid antibodies and the heart. lessons and pitfalls for the cardiologist. Circulation 84(2):920–923PubMed Asherson RA, Cervera R (1991) Antiphospholipid antibodies and the heart. lessons and pitfalls for the cardiologist. Circulation 84(2):920–923PubMed
32.
go back to reference Bouma W, Klinkenberg TJ, van der Horst IC, Wijdh-den HI, Erasmus ME, Bijl M et al (2010) Mitral valve surgery for mitral regurgitation caused by Libman-Sacks endocarditis: a report of four cases and a systematic review of the literature. J Cardiothorac Surg 5:13PubMed Bouma W, Klinkenberg TJ, van der Horst IC, Wijdh-den HI, Erasmus ME, Bijl M et al (2010) Mitral valve surgery for mitral regurgitation caused by Libman-Sacks endocarditis: a report of four cases and a systematic review of the literature. J Cardiothorac Surg 5:13PubMed
33.
go back to reference Chartash EK, Lans DM, Paget SA, Qamar T, Lockshin MD (1989) Aortic insufficiency and mitral regurgitation in patients with systemic lupus erythematosus and the antiphospholipid syndrome. Am J Med 86(4):407–412CrossRefPubMed Chartash EK, Lans DM, Paget SA, Qamar T, Lockshin MD (1989) Aortic insufficiency and mitral regurgitation in patients with systemic lupus erythematosus and the antiphospholipid syndrome. Am J Med 86(4):407–412CrossRefPubMed
34.
go back to reference Ford SE, Charrette EJ, Knight J, Pym J, Ford P (1990) A possible role for antiphospholipid antibodies in acquired cardiac valve deformity. J Rheumatol 17(11):1499–1503PubMed Ford SE, Charrette EJ, Knight J, Pym J, Ford P (1990) A possible role for antiphospholipid antibodies in acquired cardiac valve deformity. J Rheumatol 17(11):1499–1503PubMed
35.
go back to reference Ziporen L, Goldberg I, Arad M, Hojnik M, Ordi-Ros J, Afek A et al (1996) Libman-Sacks endocarditis in the antiphospholipid syndrome: immunopathologic findings in deformed heart valves. Lupus 5(3):196–205CrossRefPubMed Ziporen L, Goldberg I, Arad M, Hojnik M, Ordi-Ros J, Afek A et al (1996) Libman-Sacks endocarditis in the antiphospholipid syndrome: immunopathologic findings in deformed heart valves. Lupus 5(3):196–205CrossRefPubMed
36.
go back to reference Crozier IG, Li E, Milne MJ, Nicholls MG (1990) Cardiac involvement in systemic lupus erythematosus detected by echocardiography. Am J Cardiol 65(16):1145–1148CrossRefPubMed Crozier IG, Li E, Milne MJ, Nicholls MG (1990) Cardiac involvement in systemic lupus erythematosus detected by echocardiography. Am J Cardiol 65(16):1145–1148CrossRefPubMed
37.
go back to reference Khamashta MA, Gil A, Asherson RA, Vazquez JJ, Hughes GR (1989) Antiphospholipid antibodies, valvular heart disease and systemic lupus erythematosus. Am J Med 86(5):633–634CrossRefPubMed Khamashta MA, Gil A, Asherson RA, Vazquez JJ, Hughes GR (1989) Antiphospholipid antibodies, valvular heart disease and systemic lupus erythematosus. Am J Med 86(5):633–634CrossRefPubMed
38.
go back to reference Seward JB, Khandheria BK, Oh JK, Abel MD, Hughes RW Jr, Edwards WD et al (1988) Transesophageal echocardiography: technique, anatomic correlations, implementation, and clinical applications. Mayo Clin Proc 63(7):649–680PubMed Seward JB, Khandheria BK, Oh JK, Abel MD, Hughes RW Jr, Edwards WD et al (1988) Transesophageal echocardiography: technique, anatomic correlations, implementation, and clinical applications. Mayo Clin Proc 63(7):649–680PubMed
39.
go back to reference Shively BK, Gurule FT, Roldan CA, Leggett JH, Schiller NB (1991) Diagnostic value of transesophageal compared with transthoracic echocardiography in infective endocarditis. J Am Coll Cardiol 18(2):391–397CrossRefPubMed Shively BK, Gurule FT, Roldan CA, Leggett JH, Schiller NB (1991) Diagnostic value of transesophageal compared with transthoracic echocardiography in infective endocarditis. J Am Coll Cardiol 18(2):391–397CrossRefPubMed
40.
go back to reference Tincani A, Rebaioli CB, Taglietti M, Shoenfeld Y (2006) Heart involvement in systemic lupus erythematosus, anti-phospholipid syndrome and neonatal lupus. Rheumatol Oxf Suppl 4:iv8–iv13CrossRef Tincani A, Rebaioli CB, Taglietti M, Shoenfeld Y (2006) Heart involvement in systemic lupus erythematosus, anti-phospholipid syndrome and neonatal lupus. Rheumatol Oxf Suppl 4:iv8–iv13CrossRef
41.
go back to reference Bulkley BH, Roberts WC (1975) The heart in systemic lupus erythematosus and the changes induced in it by corticosteroid therapy. a study of 36 necropsy patients. Am J Med 58(2):243–264CrossRefPubMed Bulkley BH, Roberts WC (1975) The heart in systemic lupus erythematosus and the changes induced in it by corticosteroid therapy. a study of 36 necropsy patients. Am J Med 58(2):243–264CrossRefPubMed
42.
go back to reference Galve E, Candell-Riera J, Pigrau C, Permanyer-Miralda G, Garcia-Del-Castillo H, Soler-Soler J (1988) Prevalence, morphologic types, and evolution of cardiac valvular disease in systemic lupus erythematosus. N Engl J Med 319(13):817–823CrossRefPubMed Galve E, Candell-Riera J, Pigrau C, Permanyer-Miralda G, Garcia-Del-Castillo H, Soler-Soler J (1988) Prevalence, morphologic types, and evolution of cardiac valvular disease in systemic lupus erythematosus. N Engl J Med 319(13):817–823CrossRefPubMed
Metadata
Title
Association of antiphospholipid antibodies with valvulopathy in systemic lupus erythematosus: a systematic review
Authors
Priscila Mattos
Mittermayer B. Santiago
Publication date
01-02-2011
Publisher
Springer-Verlag
Published in
Clinical Rheumatology / Issue 2/2011
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI
https://doi.org/10.1007/s10067-010-1662-5

Other articles of this Issue 2/2011

Clinical Rheumatology 2/2011 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine