Impact of antiphospholipid antibodies on heart valve involvements in systemic lupus erythematosus: based on CSTAR cohort.

Objective: This study aims to evaluate the role of antiphospholipid antibodies (aPLs) in patients with SLE with heart valve diseases (HVDs).

Methods: This prospective study included consecutive patients with SLE who visited Peking Union Medical College Hospital between April 1999 and December 2024. Echocardiography was performed based on clinical indications. Clinical characteristics, aPL profiles and echocardiographic findings were collected. Logistic regression was used to evaluate associations between aPLs and HVD.

Results: Among 508 patients with SLE, 27.4% had HVD. The most frequently affected valves were aortic (17.3%) and mitral (11.2%) valves, with thickening (19.5%) and regurgitation (15.9%) as the leading lesion types. aPLs positive patients with SLE had higher rates of HVD (35.1% vs 24.0%, p=0.010), including valve thickening (25.3% vs 16.9%, p=0.028), regurgitation (24.7% vs 12.1%, p<0.001), vegetations (9.1% vs 0.8%, p<0.001) and stenosis (1.9% vs 0.0%, p=0.008). Anticardiolipin-IgG was associated with HVD (OR=2.484, p=0.003), mitral lesions (OR=4.156, p<0.001), valve thickening (OR=2.255, p=0.011) and regurgitation (OR=2.121, p=0.014). Anti-β2 glycoprotein I-IgG showed similar associations and was also linked to valve stenosis (OR=11.209, p=0.022). Lupus anticoagulant (LA) was associated with valve vegetations (OR=8.659, p<0.001) and interventional/surgical indications (OR=6.868, p=0.005).

Conclusion: aPLs, especially IgG isotype and LA, are independently associated with diverse HVD in SLE. Echocardiographic monitoring is warranted in aPL-positive patients.