AB0577 Characteristics of valvular heart disease in a monocentric malaysian lupus cohort
Authors: H.J. Ding, S.G. Ong, S.S. Md Sani
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Valvular heart disease (VHD) is one of the commonest cardiovascular manifestations of autoimmune disease, including systemic lupus erythematosus<sup>1</sup>. Its prevalence ranges from 18% to 74%, with predominantly regurgitant lesions and valvular thickening. The cause of such abnormalities is yet unclear. There have been very few such studies performed in Asian patients, and only one in Malaysian patients to date. <h3>Objectives</h3> We sought to evaluate the valvular abnormalities of a multiracial cohort of lupus patients and also examine the association of these abnormalities with potentially related factors. <h3>Methods</h3> The medical records of all patients with SLE who had attended the Rheumatology Clinic of Kuala Lumpur Hospital between January 2008 and December 2016 were reviewed. All patients fulfilled the 1997 updated ACR criteria for SLE. Transthoracic echocardiographic examinations as part of their standard of care were performed by trained technicians using a standardised protocol. Multivariable logistic regressions were conducted to determine factors associated with valvular abnormalities in these patients. <h3>Results</h3> There were 207 patients in this study. VHD was found in 67.1% of patients: theywere asymptomatic and did not have murmurs. The main abnormalities were tricuspid regurgitation (TR) (45.4%), mitral regurgitation (MR) (40.6%) and valvular thickening (19.2%). The majority of cases comprised mild TR (37.2%), mild MR (25.1%) and mitral valve thickening (10.6%). There were more patients with moderate to severe MR compared to TR (15.5% vs 8.2%). Median pulmonary artery systolic pressure was 23.0 mmHg (IQR 13.2). Risk of VHD was higher in patients with lower C3 levels (&lt;0.83 g/L) (OR 3.36, 95% CI 1.74–6.66). MR (83.3%) and mitral valve (MV) thickening (58.3%) were the commonest abnormalities in patients with APS. Having APS greatly increased the risk of MR (OR 8.10, 95% CI 1.65–77.95) and mitral valve thickening (OR 16.30, 95% CI 3.93–73.84). Risk of mitral valve thickening was increased by presence of lupus anticoagulant (OR 20.82, 95% CI 3.64–223.08), anticardiolipin antibody (OR 5.24, 95% CI 1.42–17.76), anti-β2GPI antibody (OR 6.35, 95% CI 1.18–37.14) and diabetes (OR 7.85, 95% CI 1.43–40.24). Risk for MR was increased by presence of lupus anticoagulant (OR 3.55, 95% CI 1.10–12.43). Hypertension was associated with an increased risk for developing aortic regurgitation (OR 4.70, 95% CI 1.67–13.44). Anti-histone antibody positivity appeared to protect against development of MR (OR 0.46, 95% CI 0.213–0.968). <h3>Conclusions</h3> More than half of our patients had VHD, with regurgitant lesions and valvular thickening being the commonest abnormalities. Our finding of the association of MR and mitral valve thickening with APS and individual antiphospholipid autoantibodies concurs with earlier studies. However, what were unusual about our cohort were that TR was the prevalent abnormality and the association of VHD with low C3. We suggest that all patients with SLE have at least one echocardiogram, especially the patients with APS or antiphospholipid antibodies. <h3>Reference</h3> [1] Bourre-Tessier J, Huynh T, Clarke AE, Bernatsky S, Joseph L, Belisle P, et al. Features associated with cardiac abnormalities in systemic lupus erythematosus. Lupus. 2011;20(14):1518–25 <h3>Disclosure of Interest</h3> None declared