Prevalence of infective endocarditis in patients with systemic lupus erythematosus

Background-Compared with the general population, patients with systemic lup us erythematosus or SLE, have an increased prevalence of functionally impai red cardiac valves due to the presence of Libman-Sacks lesions. These lesio ns 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 record s of 361 patients from two health care facilities who had the diagnostic co de of SLE. Results. Of the 275 records that met the 1982 revised American Rheumatism A ssociation 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 signific ant valvular abnormality, three (1.1 percent) had a potentially significant valvular abnormality, and one (0.4 percent) had a history of IE that was d iagnosed two years before her diagnosis of SLE was made. Conclusions. The findings suggest that 18.5 percent of this cohort of patie nts with SLE had a clinically detectable heart murmur that would require fu rther investigation to determine its significance. Furthermore, between 3.3 and 4.4 percent of the study population had cardiac valve abnormalities th at potentially required antibiotic prophylaxis before certain dental proced ures. However, the authors identified no cases that demonstrated an associa tion 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 cardia c status is unknown. Patients with confirmed valvular abnormalities should receive antibiotic prophylaxis for designated bacteremia-producing dental p rocedures.