Valvular heart disease is associated with nonfocal neuropsychiatric systemic lupus erythematosus

Background: Central nonfocal neuropsychiatric systemic lupus erythematosus (NPSLE) manifests as cognitive dysfunction, acute confusional state, seizures, and psychosis. Valvular heart disease (VHD) is currently not a causal consideration of nonfocal NPSLE. Objective: The objective of this study was to determine whether VHD is associated with nonfocal NPSLE. Methods: Twenty-eight patients with SLE underwent: 1) clinical and laboratory evaluations; 2) neuropsychiatric evaluation; 3) brain magnetic resonance imaging (MRI); and 4) transesophageal echocardiography (TEE). Their findings were compared with those of 28 age- and-sex matched healthy volunteers. Results: Eighteen patients (64%) had nonfocal NPSLE. Cerebral infarcts on MRI were more common in patients with than without NPSLE (50% vs 10%, P = 0.048) and antiphospholipid antibodies (aPL) were associated with old cerebral infarcts (P = 0.03). Valvular heart disease was detected in 20 patients (71%) of whom 20 (71%) had valve thickening, 17 (61%) had valve regurgitation, and 15 (53%) had valve vegetations (12 on the mitral valve). Mitral valve vegetations were more common in patients with than without nonfocal NPSLE and in those with old cerebral infarcts (61% vs 10% and 75% vs 30%, respectively, P <= 0.02 for both). The nonneurologic activity of SLE and mitral valve vegetations were the only independent predictors of NPSLE (odds ratio [OR], 1.27 per unit value; confidence interval [CI], 1.1-1.6; P = 0.03; and OR, 16.5; Cl, 1.26-217; P = 0.03, respectively). Among controls, none had neuropsychiatric syndromes, 4 (15%) had MRI abnormalities, and 3 (11%) had VHD (all P <= 0.001 vs patients). Conclusions: Nonfocal NPSLE, cerebral infarcts, and VHD were highly associated and mitral valve vegetations were independent predictors of NPSLE. Thus, VHD exacerbated by hypercoagulability may cause thromboembolic ischemic brain injury and nonfocal NPSLE.