Cardiac pathology of systemic lupus erythematosus

Systemic lupus erythematosus is a common chronic autoimmune disorder causing injury to many organ systems. Cardiac complications of lupus affect most parts of the heart. These include pericarditis, myocarditis, endocarditis and coronary artery disease. While many histopathological findings in lupus-related cardiac diseases are non-specific, there are a few important findings which pathologists should be aware of. This review provides pathological descriptions of these entities.

[1]  G. Chejfec Robbins Pathologic Basis of Disease , 2009 .

[2]  M. Petri,et al.  High-sensitivity C-reactive protein as an associate of clinical subsets and organ damage in systemic lupus erythematosus. , 2008, Seminars in arthritis and rheumatism.

[3]  D. Dvir,et al.  Angiographic findings and clinical outcomes in asymptomatic patients with severe obstructive atherosclerosis on computed tomography angiography. , 2008, The Israel Medical Association journal : IMAJ.

[4]  C. Roldan Valvular and coronary heart disease in systemic inflammatory diseases , 2008, Heart.

[5]  M. Halushka,et al.  New clinical and ultrastructural findings in hydroxychloroquine-induced cardiomyopathy--a report of 2 cases. , 2007, Human pathology.

[6]  S. Mathieu,et al.  Atheroma and systemic lupus erythematosus. , 2007, Joint, bone, spine : revue du rhumatisme.

[7]  E. Kasper,et al.  Comparison of survival among patients with connective tissue disease and cardiomyopathy (systemic sclerosis, systemic lupus erythematosus, and undifferentiated disease). , 2007, The American journal of cardiology.

[8]  A. Klein,et al.  Hydroxychloroquine-induced restrictive cardiomyopathy. , 2007, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[9]  H. Moutsopoulos,et al.  Libman-Sacks endocarditis in systemic lupus erythematosus: prevalence, associations, and evolution. , 2007, The American journal of medicine.

[10]  C. Lang,et al.  Altered coronary vasomotor function in young patients with systemic lupus erythematosus. , 2007, Arthritis and rheumatism.

[11]  C. Occleshaw,et al.  Spontaneous coronary artery dissection in an adolescent man with systemic lupus erythematosus , 2007, Internal medicine journal.

[12]  C. Korkmaz,et al.  Myocardial infarction in young patients (≤35 years of age) with systemic lupus erythematosus: a case report and clinical analysis of the literature , 2007, Lupus.

[13]  James O. J. Davies,et al.  Myocardial infarction in young patients without coronary atherosclerosis: assume primary antiphospholipid syndrome until proved otherwise , 2007, International journal of clinical practice.

[14]  David H. Spodick,et al.  Acute Pericarditis: Diagnostic Cues and Common Electrocardiographic Manifestations , 2007, Cardiology in review.

[15]  P. Vaideeswar,et al.  Cardiovascular involvement in systemic lupus erythematosus: an autopsy study of 27 patients in India. , 2006, Journal of postgraduate medicine.

[16]  Y. Shoenfeld,et al.  Anti-phospholipid Syndrome , 2022 .

[17]  R. Cron,et al.  Homocysteine levels and disease duration independently correlate with coronary artery calcification in patients with systemic lupus erythematosus. , 2006, Arthritis and rheumatism.

[18]  Sang-Do Lee,et al.  Clinical aspects of pulmonary hypertension in patients with systemic lupus erythematosus and in patients with idiopathic pulmonary arterial hypertension , 2006, Clinical Rheumatology.

[19]  I. Bruce Cardiovascular disease in lupus patients: should all patients be treated with statins and aspirin? , 2005, Best practice & research. Clinical rheumatology.

[20]  K. Kong,et al.  Acute lupus myocarditis: clinical features and outcome of an oriental case series , 2005, Lupus.

[21]  W. Edwards,et al.  Hydroxychloroquine-induced cardiotoxicity in a 39-year-old woman with systemic lupus erythematosus and systolic dysfunction. , 2005, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[22]  A. Marchevsky,et al.  Chloroquine-induced cardiomyopathy-echocardiographic features. , 2005, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[23]  G. Berry,et al.  Giant cell myocarditis: a rare cardiovascular manifestation in a patient with systemic lupus erythematosus , 2005, Lupus.

[24]  M. Weisman,et al.  Hydroxychloroquine cardiotoxicity in systemic lupus erythematosus: a report of 2 cases and review of the literature. , 2004, Seminars in arthritis and rheumatism.

[25]  Paolo Raggi,et al.  Premature coronary-artery atherosclerosis in systemic lupus erythematosus. , 2003, The New England journal of medicine.

[26]  R. Boldorini,et al.  The two hit hypothesis in the antiphospholipid syndrome: acute ischaemic heart involvement after valvular replacement despite anticoagulation in a patient with secondary APS , 2003, Lupus.

[27]  EK Li,et al.  Intravenous cyclophosphamide improves cardiac dysfunction in lupus myocarditis , 2003, Scandinavian journal of rheumatology.

[28]  T. Harrer,et al.  Definition of risk factors for death, end stage renal disease, and thromboembolic events in a monocentric cohort of 338 patients with systemic lupus erythematosus , 2002, Annals of the rheumatic diseases.

[29]  A. Hamsten,et al.  Cardiac valvular abnormalities are frequent in systemic lupus erythematosus patients with manifest arterial disease , 2002, Lupus.

[30]  S. Rockson,et al.  Myocarditis in systemic lupus erythematosus. , 2002, The American journal of medicine.

[31]  D. Butcovan,et al.  Cardiac consequences of the systemic lupus erythematosus therapy with corticosteroids morphological study. , 2002, Revista medico-chirurgicala a Societatii de Medici si Naturalisti din Iasi.

[32]  L. Miller Cardiovascular Toxicities of Immunosuppressive Agents , 2002, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[33]  W. Edwards,et al.  Chloroquine cardiotoxicity: clinicopathologic features in three patients and comparison with three patients with Fabry disease. , 2002, Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology.

[34]  J. Piette,et al.  Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. , 2002, Arthritis and rheumatism.

[35]  G. Thiene,et al.  Active versus borderline myocarditis: clinicopathological correlates and prognostic implications , 2002, Heart.

[36]  W. Edwards,et al.  Surgical pathology of nonbacterial thrombotic endocarditis in 30 patients, 1985-2000. , 2001, Mayo Clinic proceedings.

[37]  M. Abrahamowicz,et al.  Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. , 2001, Arthritis and rheumatism.

[38]  T. Inoue,et al.  Unusual coronary artery aneurysm and acute myocardial infarction in a middle-aged man with systemic lupus erythematosus. , 2001, The American journal of the medical sciences.

[39]  Á. Cervera,et al.  Cardiac toxicity secondary to long term treatment with chloroquine , 2001, Annals of the rheumatic diseases.

[40]  D. Gladman,et al.  Effect of antimalarial agents on the fasting lipid profile in systemic lupus erythematosus. , 2000, The Journal of rheumatology.

[41]  R. Cervera Recent advances in antiphospholipid antibody-related valvulopathies. , 2000, Journal of autoimmunity.

[42]  M. Petri Detection of coronary artery disease and the role of traditional risk factors in the Hopkins Lupus Cohort , 2000, Lupus.

[43]  T. Miller,et al.  Cardiac involvement in systemic lupus erythematosus. , 1999, Mayo Clinic proceedings.

[44]  C. Lavalle,et al.  Myocardial Infarction in Patients with Systemic Lupus Erythematosus with Normal Findings from Coronary Arteriography and Without Coronary Vasculitis , 1999, Angiology.

[45]  F. Tremel,et al.  Chloroquine cardiomyopathy with conduction disorders , 1999, Heart.

[46]  B. Strauer,et al.  Cardiac troponin T in patients with clinically suspected myocarditis. , 1997, Journal of the American College of Cardiology.

[47]  J. Ilany,et al.  Valvular dysfunction in antiphospholipid syndrome: prevalence, clinical features, and treatment. , 1997, Seminars in arthritis and rheumatism.

[48]  R. Starling,et al.  INFLAMMATORY CARDIOMYOPATHY: The Controversy of Diagnosis and Management , 1997 .

[49]  R. D'Agostino,et al.  Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. , 1997, American journal of epidemiology.

[50]  M. Crawford,et al.  An echocardiographic study of valvular heart disease associated with systemic lupus erythematosus. , 1996, The New England journal of medicine.

[51]  Y. Shoenfeld,et al.  Libman-Sacks endocarditis in the antiphospholipid syndrome: immunopathologic findings in deformed heart valves , 1996, Lupus.

[52]  W D Wagner,et al.  A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. , 1995, Arteriosclerosis, thrombosis, and vascular biology.

[53]  H. Figulla,et al.  Indium-111-antimyosin Fab imaging to demonstrate myocardial involvement in systemic lupus erythematosus. , 1995, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[54]  T. Hashimoto,et al.  [Immunohistochemical study of the endomyocardial biopsy of systemic lupus erythematosus]. , 1995, Journal of cardiology.

[55]  H. Holzhausen,et al.  Histological and ultrastructural findings in chloroquine-induced cardiomyopathy , 1995, Journal of Molecular Medicine.

[56]  V. Ferrans,et al.  Chloroquine‐Induced Cardiomyopathy , 1993, Circulation.

[57]  M. Petri,et al.  Risk factors for coronary artery disease in patients with systemic lupus erythematosus. , 1992, The American journal of medicine.

[58]  L. Kahl The spectrum of pericardial tamponade in systemic lupus erythematosus. Report of ten patients. , 1992, Arthritis and rheumatism.

[59]  Davies Mj,et al.  How can myocarditis be diagnosed and should it be treated? , 1992 .

[60]  M. Petri,et al.  Coronary Artery Disease Risk Factors in the Johns Hopkins Lupus Cohort: Prevalence, Recognition by Patients, and Preventive Practices , 1992, Medicine.

[61]  G. Chomette,et al.  [Heart conduction disorders in long-term treatment with chloroquine. Two new cases]. , 1992, Presse medicale.

[62]  E. Bates,et al.  Evaluation and treatment of acute myocardial infarction complicating systemic lupus erythematosus. , 1992, Chest.

[63]  B. Naylor Cytological Aspects of Pleural, Peritoneal and Pericardial Fluids From Patients With Systemic Lupus Erythematosus , 1992, Cytopathology : official journal of the British Society for Clinical Cytology.

[64]  R. Stone Harrison's Principles of Internal Medicine , 1991 .

[65]  C. Lau,et al.  Association between antiphospholipid antibodies and cardiac abnormalities in patients with systemic lupus erythematosus , 1990, Pediatric Nephrology.

[66]  R. Cully,et al.  Weekly clinicopathological exercises. , 1990, The New England journal of medicine.

[67]  P. Nihoyannopoulos,et al.  Cardiac abnormalities in systemic lupus erythematosus. Association with raised anticardiolipin antibodies. , 1990, Circulation.

[68]  R. Paola,et al.  Endomyocardial biopsy in diagnosis and management of cardiovascular manifestations of systemic lupus erythematosus (SLE) , 1989, Clinical Rheumatology.

[69]  J. Cosh,et al.  Rheumatic Diseases and the Heart , 1989 .

[70]  J. Reveille,et al.  Clinically significant valvular heart disease in systemic lupus erythematosus. , 1988, The American journal of medicine.

[71]  R. Scully,et al.  Case 38-1988: A 58-Year-Old Woman with Fever, Sweats, Congestive Heart Failure, and Lymphadenopathy after Treatment for a Diagnosis of Systemic Lupus Erythematosus , 1988 .

[72]  J. Myles,et al.  Chloroquine-induced cardiomyopathy. , 1988, Archives of pathology & laboratory medicine.

[73]  S. Carette Cardiopulmonary manifestations of systemic lupus erythematous. , 1988, Rheumatic diseases clinics of North America.

[74]  N. Ratliff,et al.  Chloroquine neuromyotoxicity. Clinical and pathologic perspective. , 1987, The American journal of medicine.

[75]  M. Fishbein,et al.  Echocardiographic features of nonbacterial thrombotic endocarditis. , 1987, The American journal of cardiology.

[76]  J. Myles,et al.  Diagnosis of chloroquine cardiomyopathy by endomyocardial biopsy. , 1987, The New England journal of medicine.

[77]  J. van der Walt,et al.  Systemic lupus erythematosus with coronary vasculitis and massive myocardial infarction. A case report. , 1986, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[78]  A. Ansari,et al.  Vascular Manifestations of Systemic Lupus Erythematosus , 1986, Angiology.

[79]  J. Bodet,et al.  Systemic lupus erythematosis presenting as isolated congestive heart failure. , 1985, The Journal of rheumatology.

[80]  J. van der Walt,et al.  Cardiac involvement in mixed connective tissue disease. A fatal case of scleroderma combined with systemic lupus erythematosus. , 1985, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[81]  M. Delezé,et al.  Cardiovascular Manifestations in Systemic Lupus Erythematosus. Prospective Study of 100 Patients , 1985, Angiology.

[82]  A. Ansari,et al.  Cardiovascular manifestations of systemic lupus erythematosus: current perspective. , 1985, Progress in cardiovascular diseases.

[83]  E. Lewis,et al.  Immune complex deposition and coronary vasculitis in systemic lupus erythematosus. Report of two cases. , 1984, The American journal of medicine.

[84]  G. Alroy,et al.  [Acute myocardial infarction in a young woman with systemic lupus erythematosus]. , 1984, Harefuah.

[85]  J. Kindig,et al.  Clinical utility of pericardial fluid pH determination. , 1983, The American journal of medicine.

[86]  B. Rozman,et al.  Cardiac involvement in mixed connective tissue disease. Pathomorphologic changes. , 1983, Chest.

[87]  E. Olsen,et al.  Do endomyocardial biopsies represent the morphology of the rest of the myocardium? A quantitative light microscopic study of single v. multiple biopsies with the King's bioptome. , 1982, European heart journal.

[88]  W. Roberts,et al.  Coronary arterial disease in systemic lupus erythematosus; quantification of degrees of narrowing in 22 necropsy patients (21 women) aged 16 to 37 years. , 1981, The American journal of medicine.

[89]  E. Lewis,et al.  Immunopathology of cardiac lesions in fatal systemic lupus erythematosus. , 1980, The American journal of medicine.

[90]  Y. Hiramatsu,et al.  Cardiovascular Manifestations in Systemic Lupus Erythematosus : SYMPOSIUM ON SECONDARY MYOCARDIAL DISEASE : 44th Scientific Session of the Japanise Circulation Society , 1979 .

[91]  M. Sturridge,et al.  Mitral valve replacement for mitral stenosis caused by Libman-Sacks endocarditis. , 1979, British heart journal.

[92]  M. Reza,et al.  Constrictive pericarditis in systemic lupus erythematosus. Demonstration of immunoglobulins in the pericardium. , 1978, Arthritis and rheumatism.

[93]  F. Arnett,et al.  The myocarditis of systemic lupus erythematosus: association with myositis. , 1978, Annals of internal medicine.

[94]  R. H. Feely,et al.  Systemic lupus erythematosus: a review. , 1978, Rheumatology and rehabilitation.

[95]  A. Salel,et al.  Immunopathogenesis of Libman-Sacks endocarditis. Assessment by light and immunofluorescent microscopy in two patients. , 1977, Annals of the rheumatic diseases.

[96]  Brandt Kd,et al.  Systemic lupus erythematosus. , 1977 .

[97]  W. Roberts,et al.  The heart in systemic lupus erythematosus and the changes induced in it by corticosteroid therapy: A study of 36 necropsy patients , 1975 .

[98]  J. Cassidy,et al.  Antiheart antibodies in patients with systemic lupus erythematosus , 1973, The American journal of the medical sciences.

[99]  T. Bonfiglio,et al.  Coronary arteritis, occlusion, and myocardial infarction due to lupus erythematosus. , 1972, American heart journal.

[100]  P M Moodie,et al.  COHORT , 1971, The Medical journal of Australia.

[101]  J. Haserick,et al.  Clinical Diagnosis of Cardiac Involvement in Systemic Lupus Erythematosus: A Correlation of Clinical and Autopsy Findings in Thirty Patients , 1962, Circulation.

[102]  E. Bywaters,et al.  THE HEART IN SYSTEMIC LUPUS ERYTHEMATOSUS , 1960, British heart journal.

[103]  M. Shearn The heart in systemic lupus erythematosus. , 1959, American heart journal.

[104]  L. Shulman,et al.  SYSTEMIC LUPUS ERYTHEMATOSUS: REVIEW OF THE LITERATURE AND CLINICAL ANALYSIS OF 138 CASES , 1954, Medicine.

[105]  R. Jessar,et al.  Natural history of lupus erythematosus disseminatus. , 1953, Annals of internal medicine.

[106]  G. Griffith,et al.  Acute and Subacute Disseminated Lupus Erythematosus: A Correlation of Clinical and Postmortem Findings in Eighteen Cases , 1951, Circulation.

[107]  L. Gross The cardiac lesions in Libman-Sacks disease: With a consideration of its relationship to acute diffuse lupus erythematosus. , 1940, The American journal of pathology.

[108]  E. Libman,et al.  A HITHERTO UNDESCRIBED FORM OF VALVULAR AND MURAL ENDOCARDITIS , 1924 .

[109]  Qianqian Wang,et al.  Patients with Systemic Lupus Erythematosus , 1999 .

[110]  G. Geri,et al.  [Cardiac involvement in antiphospholipid syndrome]. , 2011, Presse medicale.

[111]  D. Isenberg,et al.  Systemic Lupus Erythematosus , 2008 .

[112]  L. Pasquier,et al.  Orphanet Journal of Rare Diseases , 2006 .

[113]  J. Flores Serrano,et al.  [Endomyocardial fibrosis or Davies disease]. , 2005, Anales de pediatria.

[114]  R. Paola,et al.  The role of endomyocardial biopsy in the diagnosis of cardiac involvement in systemic lupus erythematosus , 2005, Heart and Vessels.

[115]  C. Lau,et al.  Acute hemorrhagic myocarditis in systemic lupus erythematosus , 2005, Heart and Vessels.

[116]  Y. Nimura,et al.  Right Ventricular Growth in a Case of Pulmonic Stenosis with Intact Ventricular Septum and Hypoplastic Right Ventricle , 2005 .

[117]  Karen Birmingham,et al.  the heart , 2002, Nature.

[118]  R. Omdal,et al.  Transesophageal and transthoracic echocardiography and Doppler-examinations in systemic lupus erythematosus. , 2001, Scandinavian journal of rheumatology.

[119]  C. Lavalle,et al.  Endomyocardial fibrosis (Davies disease) coincidental with systemic lupus erythematosus. , 2000, Archivos del Instituto de Cardiologia de Mexico.

[120]  C. Lavalle,et al.  Edomyocardial fibrosis (Davies disease) coincidental with systemic lupus erythematosus , 2000 .

[121]  A. Frustaci,et al.  Acute myocarditis and left ventricular aneurysm as presentations of systemic lupus erythematosus. , 1996, Chest.

[122]  E. Brahn,et al.  Systemic lupus erythematosus: calciphylaxis induced cardiomyopathy. , 1995, The Journal of rheumatology.

[123]  M. Macro,et al.  Severe lupus with infectious thyroiditis and lethal cardiomyopathy. , 1995, Clinical and experimental rheumatology.

[124]  M. Davies,et al.  How can myocarditis be diagnosed and should it be treated? , 1992, British heart journal.

[125]  R. Scully,et al.  Case records of the Massachusetts General Hospital. , 1990 .

[126]  T. Moore,et al.  Endomyocardial biopsy in patients with systemic lupus erythematosus. , 1988, The Journal of rheumatology.

[127]  Frcp John A. Cosh MA MD,et al.  Rheumatic Diseases and the Heart , 1988, Springer London.

[128]  B. Wechsler,et al.  Chloroquine cardiotoxicity. , 1987, The New England journal of medicine.

[129]  M. Ito,et al.  Cardiovascular manifestations in systemic lupus erythematosus. , 1979, Japanese circulation journal.

[130]  L. E. Watts,et al.  Cardiopulmonary manifestations of systemic lupus erythematosus. , 1978, The Journal of rheumatology.

[131]  R. Knodell,et al.  Staphylococcal pericarditis in a patient with systemic lupus erythematosus. , 1974, Chest.

[132]  S. Robbins,et al.  Pathologic basis of disease , 1974 .

[133]  E. Humphreys The cardiac lesions of acute disseminated lupus erythematosus. , 1948, Annals of internal medicine.