title: Lambl's Excrescences: Association with Cerebrovascular Disease and Pathogenesis.
abstract: BACKGROUND
  Lambl's excrescences (LEx) are detected by transesophageal echocardiography (TEE) and are characterized as thin, elongated, and hypermobile structures located at the leaflets' coaptation point of the heart valves. The association of LEx with cerebrovascular disease (CVD) is still undefined and yet patients with LEx and suspected CVD receive unproven effective antiplatelet or anticoagulant therapy or even undergo valve surgery. Also, the association of LEx with aging and atherogenic, inflammatory, or thrombogenic parameters has not been reported.
  
  
  METHODS
  Seventy-seven patients with systemic lupus erythematosus (SLE) (71 women, age 37 ± 12 years) and 26 age- and sex-matched healthy controls (22 women, age 34 ± 11 years) prospectively underwent routine history and physical exam, transcranial Doppler, brain MRI, TEE, carotid duplex, and clinical and laboratory evaluations of atherogenesis, inflammation, platelet activity, coagulation, and fibrinolysis. Subjects without stroke/TIA on enrollment (with and without LEx) had a median follow-up of 57 months.
  
  
  RESULTS
  On enrollment, 33 (43%) of 77 patients had CVD manifested as acute stroke/TIA (23 patients), cerebromicroembolism by transcranial Doppler (17 patients), or cerebral infarcts by MRI (14 patients). Mitral or aortic valve LEx were equally frequent in healthy controls (46%) as in patients with and without any CVD (39 and 43%), stroke/TIA (35 and 43%), cerebromicroembolism (41 and 42%), or cerebral infarcts (36 and 43%) (all p ≥ 0.72). Also, other mechanisms for CVD other than LEx such as Libman-Sacks vegetations, patent foramen ovale or interatrial septal aneurysm, aortic or carotid atherosclerosis, or thrombogenesis were found in ≥94% of patients with CVD. In addition, 36 subjects with and 44 without LEx had similar low incidence of stroke/TIA (1 (1.3%) and 2 (2.5%), respectively, p = 1.0) during follow-up. Finally, LEx were not associated with aging, atherogenic risk factors, atherosclerosis, inflammation, or thrombogenesis.
  
  
  CONCLUSIONS
  In this study, LEx are similarly prevalent in healthy controls and SLE patients, are not associated with CVD, and are not associated with pathogenic risk factors. Therefore, the study findings suggest that LEx may not be cardioembolic substrates, may not represent pathologic valve structures, and may not require therapy.
authors.affiliation: Department of Medicine, Divisions of Cardiology and Rheumatology, University of New Mexico School of Medicine, Albuquerque, N.M., USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Roldan
authors.forename: Oleksandr
authors.initials: O
authors.lastname: Schevchuck
authors.forename: Kirsten
authors.initials: K
authors.lastname: Tolstrup
authors.forename: Paola C
authors.initials: PC
authors.lastname: Roldan
authors.forename: Leonardo
authors.initials: L
authors.lastname: Macias
authors.forename: Clifford R
authors.initials: CR
authors.lastname: Qualls
authors.forename: Ernest R
authors.initials: ER
authors.lastname: Greene
authors.forename: Reyaad
authors.initials: R
authors.lastname: Hayek
authors.forename: Gerald A
authors.initials: GA
authors.lastname: Charlton
authors.forename: Wilmer L
authors.initials: WL
authors.lastname: Sibbitt
mesh_terms: D000293:Adolescent; D000328:Adult; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006351:Heart Valves / Q000000981:diagnostic imaging; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D017585:Ultrasonography, Doppler, Transcranial; D055815:Young Adult