Prevalence of infective endocarditis in patients with systemic lupus erythematosus

Craig S. Miller, Rita M. Egan, Donald A. Falace, Mary Kay Rayens, Charles R. Moore

Research output: Contribution to journalArticlepeer-review

25 Scopus citations

Abstract

Background. Compared with the general population, patients with systemic lupus erythematosus, or SLE, have an increased prevalence of functionally impaired cardiac valves due to the presence of Libman-Sacks lesions. These lesions may place patients with SLE at risk of developing infective endocarditis, or IE. Methods. The authors performed a retrospective chart review to determine the association between SLE with valvulopathy and IE. They reviewed the records of 361 patients from two health care facilities who had the diagnostic code of SLE. Results. Of the 275 records that met the 1982 revised American Rheumatism Association criteria for SLE, 51 (18.5 percent) were for patients who had a clinically detectable heart murmur that resulted in echocardiography being performed. Nine (3.3 percent) of the 275 patients had a clinically significant valvular abnormality, three (1.1 percent) had a potentially significant valvular abnormality, and one (0.4 percent) had a history of IE that was diagnosed two years before her diagnosis of SLE was made. Conclusions. The findings suggest that 18.5 percent of this cohort of patients with SLE had a clinically detectable heart murmur that would require further investigation to determine its significance. Furthermore, between 3.3 and 4.4 percent of the study population had cardiac valve abnormalities that potentially required antibiotic prophylaxis before certain dental procedures. However, the authors identified no cases that demonstrated an association between IE and diagnosed SLE. Clinical Implications. Dentists should query their patients with SLE about their cardiac status and consult with the patient's physician if the cardiac status is unknown. Patients with confirmed valvular abnormalities should receive antibiotic prophylaxis for designated bacteremia-producing dental procedures.

Original languageEnglish
Pages (from-to)387-392
Number of pages6
JournalJournal of the American Dental Association
Volume130
Issue number3
DOIs
StatePublished - Mar 1999

Bibliographical note

Funding Information:
We conducted a retrospective chart review of all inpatients and outpatients attending the University of Kentucky Medical Center, or UKMC, and the Lexington Clinic Foundation (a large community group prac tice) from 1980 to 1995 who had SLE according to the diagnostic code established by the International Classification of Diseases, 9th Revision, Clinical Modification, or ICD-9-CM.34 Our goal was to determine the prevalence of IE among these patients. We accepted the diag nosis of SLE only when four of the 11 diagnostic criteria from the revised criteria for SLE of the American Rheumatism Association, or ARA, were ful filled.35 The diagnosis of IE was accepted when at least two posi tive blood cultures were detect ed in association with a new or changing cardiac murmur and echocardiographic evidence of valvular vegetations. The final cohort consisted of 275 patients with SLE, 117 from UKMC and 158 from the Lexington Clinic.

ASJC Scopus subject areas

  • General Dentistry

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