Background/Purpose: Cardiovascular involvement including pericardium, conduction system, coronary arteries and valvular abnormalities are frequent manifestations of SLE. It is estimated to occur in more than 50% of SLE patients and the prevalence is increasing in the setting of imaging modalities like echocardiogram. Studies have shown approximately 11 times higher risk of any valvular abnormalities in SLE, with mitral valve regurgitation being the most common among them. The mechanism of injury and risk factors are still not completely understood. While association of antiphospholipid antibodies and SLE related valve disease is well known, role of other antibodies like SSA and Anti-Smith remains poorly defined. Recent studies have shown the increased incidence of SSA antibodies in SLE and their positive association with severe mitral valve regurgitation. Though the detection of the early or minor changes by using echocardiography may be limited, these parameters are reliable for all-cause mortality and cardiac morbidity. We sought to test the association between valvular abnormalities and SSA antibodies in SLE patients without clinical cardiovascular disease (CVD).

Methods:   Adult SLE patients without clinical CVD continuously seen at a University Lupus Center between April 2016 and March 2017, meeting 1997 ACR classification criteria for SLE were studied. Patient characteristics including demographics, SLE-specific features, medication use, traditional CVD risk factors, 12-lead electrocardiogram (EKG) were ascertained. Trans Thoracic Echocardiogram (TTE) was obtained mainly retrospectively from within one year of the date of enrolment. Univariable and multivariable linear regression models were constructed to test the association of SSA antibodies with valvular abnormalities.

Results: Sixty-four SLE patients (baseline characteristics in table 1) were studied. In univariable analyses, presence of SSA antibodies was significantly associated with a higher incidence of any valvular abnormality (OR= 5.8, P = 0.042) , mitral valve regurgitation ( OR= 3.08, p=0.05) and tricuspid valve regurgitation (TVR)  ( OR = 4.95, p= 0.018) . Multivariable regression models showed the absence of any confounders. There were a total of 54 (84%)  valvular abnormalities with TVR being the most common at 49 (77%).

Conclusion: SSA Antibodies are associated with valvular abnormalities with TVR being most common in SLE patients without clinical cardiovascular disease