{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T18:49:47Z","timestamp":1793299787882,"version":"4.5.0"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2021,2,16]],"date-time":"2021-02-16T00:00:00Z","timestamp":1613433600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"National Institutes of Health\/National Heart Lung and Blood Institute","award":["RO1-HL0472201"],"award-info":[{"award-number":["RO1-HL0472201"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Libman-Sacks endocarditis in patients with systemic lupus erythematosus (SLE) is commonly complicated with embolic cerebrovascular disease (CVD) or valve dysfunction for which high-risk valve surgery is frequently performed. However, the role of medical therapy alone for Libman-Sacks endocarditis and associated acute CVD remains undefined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine in this cross-sectional and longitudinal study if conventional anti-inflammatory and anti-thrombotic therapy may be an effective therapy in SLE patients with Libman-Sacks endocarditis and associated acute CVD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods and materials<\/jats:title>\n                    <jats:p>17 SLE patients with Libman-Sacks endocarditis detected by two-and-three-dimensional transesophageal echocardiography (TEE) and complicated with acute CVD [stroke\/TIA, focal brain injury on MRI, or cognitive dysfunction] were treated with conventional anti-inflammatory and anti-thrombotic therapy for a median of 6 months and then underwent repeat TEE, transcranial Doppler, brain MRI, and neurocognitive testing for re-assessment of Libman-Sacks endocarditis and CVD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Valve vegetations decreased in number, diameter, and area (all p \u22640.01); associated valve regurgitation significantly improved (p = 0.04), and valve thickening did not progress (p = 0.56). In 13 (76%) patients, valve vegetations or valve regurgitation resolved or improved in number and size or by \u22651 degree, respectively, as compared to 4 (24%) patients in whom vegetations or valve regurgitation persisted unchanged or increased in size or by \u22651 degree (p = 0.03). Also, cerebromicroembolism, lobar and global gray and white matter cerebral perfusion, ischemic brain lesion load, and neurocognitive dysfunction resolved or significantly improved (all p \u22640.04).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These preliminary data suggest that combined conventional anti-inflammatory and antithrombotic therapy may be an effective treatment for Libman-Sacks endocarditis and its associated CVD and may obviate the need for high-risk valve surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0247052","type":"journal-article","created":{"date-parts":[[2021,2,16]],"date-time":"2021-02-16T16:39:33Z","timestamp":1613493573000},"page":"e0247052","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":32,"title":["Libman-Sacks endocarditis and associated cerebrovascular disease: The role of medical therapy"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1826-5878","authenticated-orcid":true,"given":"Carlos A.","family":"Roldan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilmer L.","family":"Sibbitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernest R.","family":"Greene","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clifford R.","family":"Qualls","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rex E.","family":"Jung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,2,16]]},"reference":[{"key":"pone.0247052.ref001","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1016\/j.jcmg.2013.04.012","article-title":"Libman-Sacks endocarditis and embolic cerebrovascular disease.","volume":"6","author":"CA Roldan","year":"2013","journal-title":"JACC Cardiovasc Imaging"},{"key":"pone.0247052.ref002","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1016\/j.amjcard.2005.02.010","article-title":"Valvular heart disease as a cause of cerebrovascular disease in patients with systemic lupus erythematosus","volume":"95","author":"CA Roldan","year":"2005","journal-title":"Am J Cardiol"},{"key":"pone.0247052.ref003","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1016\/j.echo.2015.02.011","article-title":"Libman-Sacks Endocarditis: Detection, Characterization, and Clinical Correlates by Three-Dimensional Transesophageal Echocardiography.","volume":"28","author":"CA Roldan","year":"2015","journal-title":"J Am Soc Echocardiogr"},{"key":"pone.0247052.ref004","first-page":"269","article-title":"Cardiac surgery in systemic lupus erythematosus patients: Clinical characteristics and outcomes","volume":"14","author":"J Tejeda-Maldonado","year":"2018","journal-title":"Reumatol Clin"},{"key":"pone.0247052.ref005","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/1749-8090-5-13","article-title":"Mitral valve surgery for mitral regurgitation caused by Libman-Sacks endocarditis: a report of four cases and a systematic review of the literature","volume":"5","author":"W Bouma","year":"2010","journal-title":"J Cardiothorac Surg"},{"key":"pone.0247052.ref006","doi-asserted-by":"crossref","first-page":"216291","DOI":"10.1155\/2014\/216291","article-title":"Mitral valve surgery in patients with systemic lupus erythematosus","volume":"2014","author":"M Foroughi","year":"2014","journal-title":"Scientific World Journal"},{"key":"pone.0247052.ref007","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1136\/annrheumdis-2019-215089","article-title":"2019 update of the EULAR recommendations for the management of systemic lupus erythematosus","volume":"78","author":"A Fanouriakis","year":"2019","journal-title":"Ann Rheum Dis"},{"key":"pone.0247052.ref008","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1093\/rheumatology\/keu482","article-title":"EULAR recommendations for neuropsychiatric systemic lupus erythematosus vs usual care: results from two European centres","volume":"54","author":"C Pamfil","year":"2015","journal-title":"Rheumatology (Oxford)"},{"key":"pone.0247052.ref009","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.1136\/annrheumdis-2012-201940","article-title":"Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR\/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. 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