Abstract 10912: Lambl’s Excrescences: Embolic Risk and Pathogenesis
Background: Lambl’s excrescences (LEx) are commonly detected by transesophageal echocardiography (TEE) in patients with suspected cardioembolism. However, LEx are detected in healthy subjects and patients without cardioembolism. Therefore, the embolic risk of LEx is controversial and their pathogenesis undefined. Patients with systemic lupus erythematosus (SLE) often have LEx, acute neurologic syndromes, brain lesions on MRI, cerebromicroembolism, and inflammation and hypercoagulability. This controlled, cross-sectional, and longitudinal study was conducted to assess the embolic risk and pathogenesis of LEx using SLE as a disease model.
Methods: 31 SLE patients with acute neurologic syndromes [stroke/TIA (n=23), cognitive dysfunction (n=11), confusion (n=7), or seizures (n=4)], 46 matched SLE controls without acute neurologic syndromes, and 26 age-and-sex frequency matched healthy controls underwent TEE, carotid duplex, brain MRI, neurocognitive testing, transcranial Doppler, and clinical and laboratory evaluations of inflammation, platelet activity, coagulation, and fibrinolysis. Subjects with and without LEx and no acute neurologic syndromes on enrollment were followed for 58 months.
Results: LEx on the mitral or aortic valve were equally frequent in controls (58%) and SLE patients with and without acute neurologic syndromes (52% and 59%), stroke/TIA (43% and 61%), focal brain lesions on MRI (50% and 61%), cognitive dysfunction (59% and 53%), and cerebromicroembolism (65% and 53%) (all p≥0.41). Other known sources of cardioembolism, atheroembolism or atherothrombosis, or hypercoagulability were found in 94%-100% of SLE patients with acute neurologic syndromes, brain lesions, cognitive dysfunction, or cerebromicroembolism. Patients and controls with and without LEx had similar parameters of inflammation and hypercoagulability. In 9 patients with 13 LEx, 12 LEx persisted unchanged on follow-up TEE after 2.4 months of anti-inflammatory and antithrombotic therapy. Finally, 49 subjects with and 23 without LEx had similar low incidence of stroke/TIA [2 (4%) and 0, respectively, p=1.0].
Conclusion: . LEx may not be cardioembolic substrates, may not represent pathologic valve structures, and may not require therapy.
- © 2013 by American Heart Association, Inc.