Background Libman-Sacks (LS) endocarditis is one of the major cardiac involvement of systemic lupus erythematosus (SLE) and can manifest with neuropsychiatric events including stroke. However, data on the clinical features of LS endocarditis in comparison with infective endocarditis are limited. Thus, we compared SLE patients with LS endocarditis and those with infective endocarditis and analyzed the long-term clinical outcomes.
Methods We reviewed the medical records of SLE patients who were diagnosed with LS endocarditis or infective endocarditis between 1990 and 2021. Poor outcomes were defined as the occurrence of stroke, transient ischemic attack, or seizure during follow-up.
Results A total of 47 patients with LS endocarditis were compared with 5 patients with infective endocarditis. Patients with LS endocarditis were less likely to have fever, chest pain, and vegetation (40.4% vs. 100%, p=0.019) and had smaller vegetation size (median, 0 mm, vs. 12 mm, p=0.008) compared with those with infective endocarditis. Of the 37 patients with LS endocarditis who were followed for more than one year, 11 patients had poor outcomes, who had a significantly higher rate of vegetation (63.6% vs. 29.2%, p=0.048) and a lower rate of pericardial effusion (27.3% vs. 66.7%, p=0.039) than those without poor outcomes. The presence of vegetation and pericardial effusion were significantly associated with the development of poor outcomes.
Conclusions Patients with LS endocarditis had different clinical features compared with those with infective endocarditis. Neuropsychiatric outcomes occurred in approximately 30% of patients with LS endocarditis during follow-up, and the presence of vegetation and pericardial effusion were significant factors for the development of poor outcomes.
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