Risultati per: Diagnosi e trattamento della nefrite da lupus

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Circulation, Volume 150, Issue Suppl_1, Page A4147071-A4147071, November 12, 2024. Introduction/Background:Marantic endocarditis and valvulitis are cardiovascular manifestations of autoimmune disease that can be challenging to diagnose.Case Presentation:A 23-year-old female with SLE presented with brief episodes of intermittent left eye vision loss and left sided weakness. She also reported fevers, a malar rash, and new onset dyspnea on exertion.Serologic work-up was consistent with an SLE flair. MRI of the brain/orbits demonstrated two acute infarcts in the frontal and parieto-occipital lobes. CTA head and neck did not show any large vessel vasculitis. Transthoracic echocardiography showed thickening of the mitral valve (MV) leaflets, with moderate MR and an elevated MV gradient of 11 mm Hg. The posterior leaflet was not visualized, concerning for absent or hypoplastic posterior leaflet. A transesophageal echocardiogram was performed and showed severe thickening of posterior mitral leaflet with restricted motion and shortening secondary to extensive thrombus burden. In addition, there was evidence of thrombus at the tip of the anterior MV leaflet. The patient was managed with high dose steroids and warfarin for SLE flair and marantic endocarditis, respectively.Two months later, she presented with amaurosis fugax. Cardiac MRI showed thickened MV leaflets with delayed enhancement along the posterior leaflet and MV annulus consistent with an organized thrombus. After multidisciplinary discussion, the patient underwent surgical MV replacement with a bioprosthetic valve. Intraoperative evaluation revealed severely thickened MV leaflets with fused commissures. In addition, there was fusion of the posterior leaflet and lateral side of the anterior leaflet to the papillary muscles as a result of thickened and shortened chordae. These findings were believed to be due to inflammatory changes involving the MV apparatus. Surgical pathology confirmed the diagnosis of valvulitis. The patient has done well post operatively.Conclusion:Valvulitis and marantic endocarditis can have devastating consequences if not treated promptly. Use of multimodality imaging can aid in the diagnosis. Multidisciplinary discussion is critical in achieving desired clinical outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4145236-A4145236, November 12, 2024. Introduction:Studies have reported on the prevalence, and associations between acute myocardial infarction (AMI) and systemic lupus erythematosus (SLE), but there is limited data on the predictors of mortality and whether these differ among patients with a diagnosis of SLE. We examined the factors associated with mortality among hospitalized patients with a diagnosis of AMI with or without SLE.Hypothesis:Patient and hospital associated factors can predict mortality among hospitalized patients with AMI and these predictors differ by SLE diagnosisMethods:The National Inpatient Sample (NIS) data collected from 2016 – 2020 was utilized to conduct retrospective cohort analyses. Multivariate logistic regression models were used to examine the factors associated with mortality among hospitalized patients with AMI by SLE diagnosis.Results:Among SLE patients with a diagnosis of AMI, being female (AOR: 1.53; 95% CI: 1.02-1.86) and 65 years and above (AOR: 1.65; 95% CI: 1.20-2.74) was associated with higher odds of mortality compared to being male and younger than 65 years. Elective admission (AOR: 0.59; 95% CI: 0.39-0.85) was associated with lower risk of mortality relative to non-elective admission. Of note, non-Hispanic blacks (AOR: 0.68; 95% CI: 0.39-0.98) had lower odds of mortality than non-Hispanic whites. Patients with length of stay greater than 5 days (AOR: 1.75; 95% CI: 1.18-2.59) were more likely to die than those with hospital stay 5 days or less. Higher comorbidity scores were also associated with higher odds of mortality. Among patients without SLE, non-Hispanic blacks (AOR: 1.68; 95% CI: 1.07–2.48) reported higher mortality compared to their non-Hispanic white counterparts. Additionally, being on private insurance (AOR: 0.75; 95% CI: 0.32–0.99) was associated with lower odds of mortality relative to Medicare insurance.Conclusion:Our study highlights patients and hospital related factors that can predict mortality among patients hospitalized with AMI by SLE. Further studies are needed to explore these factors as it will help physicians identify patients that need closer monitoring.

Circulation, Volume 150, Issue Suppl_1, Page A4145271-A4145271, November 12, 2024. A 42-year-old female with SLE, lupus cerebritis with related seizure disorder, and mesenteric venous thrombosis on warfarin initially presented for syncope. Acute stroke workup was negative, and syncope was attributed to possible brief seizure. Six months later, the patient was evaluated by cardiology for hypertension diagnosed during hospitalization. She reported no further syncope, but exam revealed a 3/6 holosystolic murmur. Subsequent TTE identified severe MR with primary MV degeneration and LVEF >60%. A TEE confirmed severe MR with myxomatous MV leaflets and moderate-sized nonmobile vegetations attached to the atrial side of A2 and P2 of the MV. Subsequent infectious workup including serial blood cultures were negative. The patient was diagnosed with non-bacterial Libman-Sacks endocarditis (LSE). Given a lack of symptoms and plan to resume immunosuppressive therapy and continue her anticoagulation (AC), surgical intervention was initially deferred with close follow-up.The patient continued to endorse worsening headaches and brain MRI revealed new chronic small ischemic strokes. One morning, the patient noted sudden aphasia and presented to the ED. Stroke workup revealed an acute ischemic stroke with total left M2 occlusion of her MCA, and she underwent thrombectomy. Cerebral angiogram further revealed FMD. Given ongoing embolic phenomena, likely from LSE, she underwent MVR with mechanical valve and LA appendage ligation and continued mycophenolate and warfarin. Two months postoperatively, the patient remained asymptomatic with normal prosthetic valve function and neurologic status. However, evaluation for extracranial FMD with CTA revealed interval development of PV vegetations. These lesions and moderate PR were confirmed on TTE.Discussion:While response to immunosuppressive therapy and AC has been reported to improve early-phase LSE, this patient continued to experience thromboembolic events resulting from LSE vegetations while on mycophenolate and warfarin. Despite continuing these therapies after MVR, she later developed PV vegetations and PR. Pulmonary valve involvement is rare in LSE, and development of new disease while on recommended medical therapy represents unusual disease progression.

Circulation, Volume 150, Issue Suppl_1, Page A4138497-A4138497, November 12, 2024. BACKGROUND/PURPOSE:Pericarditis is the most common cardiac manifestation of systemic lupus erythematosus (SLE). In the general population, pericarditis commonly recurs (~30%), likely due to immune-mediated mechanisms. Given the broad immune dysregulation that drives the pathogenesis of SLE, we sought to identify the frequency and risk factors for the recurrence of pericarditis in this unique population.METHODS:Retrospective cohort study of SLE patients enrolled between 1988 and 2023 at a tertiary medical center. The SELENA revision of the SLE Disease Activity Index was used to define pericarditis, and all follow-up clinical encounters were examined after the first reported episode. Recurrent pericarditis was defined as that occurring at least 6 weeks after the first recorded episode of pericarditis. Statistical significance was defined as a p-value of

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