{"schema":"https://ver.cy/schemas/card/1.0.0","id":"vr.tr.libman-sacks-endocarditis","code":"thing-q1532243","url":"https://ver.cy/models/thing/q1532243/","name":"Libman–Sacks endocarditis","alternateNames":[],"kind":"thing","status":"published","version":"0.1.0-research.1","language":"en","classifiers":{"family":"Thing Registry","category":"Information and virtual systems","entryKind":"thing","plane":"INF","domain":["INF.KNW"],"industry":[],"navPath":"","tags":[],"facets":{}},"whatItIs":"Libman-Sacks endocarditis is a form of noninfective endocarditis characterized by sterile verrucous vegetations, predominantly on the mitral and aortic valves, associated especially with systemic lupus erythematosus and antiphospholipid syndrome.","purpose":"Enable an agent to recognise Libman-Sacks endocarditis, assess its valve and embolic consequences, and identify evidence needed for clinician-directed decisions.","scope":{"in":["Noninfective valvular lesions attributed to Libman-Sacks endocarditis and the certainty of that attribution.","Lesion location, morphology, imaging provenance, and available tissue evidence.","Relationships to systemic lupus erythematosus and antiphospholipid syndrome.","Assessment of competing diagnoses, especially infective endocarditis and other nonbacterial thrombotic endocarditis.","Valve dysfunction, suspected embolic consequences, and changes during follow-up.","Condition-specific evidence supporting monitoring and treatment review."],"out":["The patient's identity and complete medical history.","Full diagnostic and management models for systemic lupus erythematosus or antiphospholipid syndrome.","Infective endocarditis and malignancy-associated nonbacterial thrombotic endocarditis as independent conditions.","Independent stroke, heart failure, or systemic embolism models.","Encounter administration, procedure execution, and medication prescribing."],"boundaries":[]},"distinguishingFeatures":["Establish whether noninfective valve lesions occur in a relevant autoimmune context; systemic lupus erythematosus or antiphospholipid syndrome alone does not establish Libman-Sacks endocarditis. [Diagnostic TEE study](https://pubmed.ncbi.nlm.nih.gov/19763069/)","Assess for sessile, nodular or coalescent vegetations at leaflet coaptation, potentially extending across leaflet surfaces; these are supportive imaging patterns rather than definitive identifiers. [Three-dimensional TEE study](https://pmc.ncbi.nlm.nih.gov/articles/PMC4592775/)","Distinguish a supported noninfective attribution from unresolved infective endocarditis through microbiology, clinical evidence, and serial imaging; negative cultures alone should not determine the label. [Diagnostic case study](https://pmc.ncbi.nlm.nih.gov/articles/PMC2517866/)","Distinguish this autoimmune-associated condition from other causes of nonbacterial thrombotic endocarditis by recording the underlying attribution and the terminology used by the diagnosing source.","Separate characteristic vegetations from isolated nonspecific valve thickening and from imaging artifacts; record modality limitations when lesions are absent or equivocal. [TTE versus TEE study](https://pubmed.ncbi.nlm.nih.gov/18085739/)"],"structure":{"bundles":[{"id":"condition-identity-and-attribution","name":"Condition identity and attribution","description":"Define which autoimmune-associated valve condition the registry entry denotes and how a particular diagnosis is supported.","layers":[{"id":"terminological-boundary","name":"Terminological boundary","description":"Preserve the distinction between Libman-Sacks endocarditis and neighbouring valve conditions.","findings":[{"id":"libman-sacks-concept-boundary","name":"Libman-Sacks concept boundary","description":"Record the source's intended meaning and its relationship to the broader nonbacterial thrombotic endocarditis category.","questions":[{"text":"Does the diagnosing source use Libman-Sacks specifically for autoimmune-associated lesions or as a broader synonym?","id":"libman-sacks-concept-boundary-q01","kind":"definition"},{"text":"What evidence distinguishes this attribution from malignancy-associated or otherwise unexplained nonbacterial thrombotic endocarditis?","id":"libman-sacks-concept-boundary-q02","kind":"boundary"}]}]},{"id":"diagnostic-assertion","name":"Diagnostic assertion","description":"Represent who made the diagnosis, its certainty, and the framework used.","findings":[{"id":"attribution-evidence-and-version","name":"Attribution evidence and version","description":"Keep the diagnostic assertion distinct from the condition, its supporting observations, and the care encounter.","questions":[{"text":"Who attributed the lesions to Libman-Sacks endocarditis, when, and using which imaging, clinical, or pathological evidence?","id":"attribution-evidence-and-version-q01","kind":"provenance"},{"text":"If diagnostic criteria or a terminology code are recorded, what issuing body, edition, jurisdiction, and mapping source apply?","id":"attribution-evidence-and-version-q02","kind":"provenance"},{"text":"Is the assertion suspected, clinically supported, tissue-supported, disputed, or excluded, and what uncertainty remains?","id":"attribution-evidence-and-version-q03","kind":"definition"}]}]}]},{"id":"valve-lesions-and-observation","name":"Valve lesions and observation","description":"Describe individual lesions and the examinations that make them observable.","layers":[{"id":"lesion-anatomy","name":"Lesion anatomy","description":"Locate and characterise vegetations and associated leaflet changes.","findings":[{"id":"vegetation-topography-and-morphology","name":"Vegetation topography and morphology","description":"Record valve, leaflet surface, attachment, shape, mobility, and dimensions as observations rather than diagnostic proof.","questions":[{"text":"Which valve, leaflet or cusp, and surface carry each lesion, and does it extend across the leaflet or coaptation region?","id":"vegetation-topography-and-morphology-q01","kind":"measurement"},{"text":"What dimensions, attachment breadth, mobility, and echogenicity were reported for each lesion?","id":"vegetation-topography-and-morphology-q02","kind":"measurement"},{"text":"What distinguishes the observed mass from isolated thickening, a strand, a tumour, or an artifact?","id":"vegetation-topography-and-morphology-q03","kind":"boundary"}]}]},{"id":"imaging-and-tissue-provenance","name":"Imaging and tissue provenance","description":"Capture the technique and limitations behind positive or negative observations.","findings":[{"id":"examination-detection-confidence","name":"Examination detection confidence","description":"TEE detected lesions more effectively than TTE in a comparative SLE study; an absent finding must therefore retain its examination context. [Comparative study](https://pubmed.ncbi.nlm.nih.gov/18085739/)","questions":[{"text":"Was the observation obtained using TTE, two-dimensional TEE, three-dimensional TEE, or tissue examination, and on what date?","id":"examination-detection-confidence-q01","kind":"provenance"},{"text":"Which image-quality or sampling limitations constrain interpretation of an absent or equivocal lesion?","id":"examination-detection-confidence-q02","kind":"measurement"},{"text":"Would additional imaging or review of existing tissue resolve a specific uncertainty sufficiently to justify clinician consideration?","id":"examination-detection-confidence-q03","kind":"action"}]}]}]},{"id":"autoimmune-context-and-infection-differential","name":"Autoimmune context and infection differential","description":"Connect the autoimmune setting to lesion attribution while preserving assessment of infection.","layers":[{"id":"autoimmune-associations","name":"Autoimmune associations","description":"Link independently assessed lupus and antiphospholipid findings to the valve condition.","findings":[{"id":"lupus-and-antiphospholipid-evidence","name":"Lupus and antiphospholipid evidence","description":"Record associated diagnoses, antibody evidence, and their timing without converting an isolated antibody result into an antiphospholipid syndrome diagnosis.","questions":[{"text":"Is systemic lupus erythematosus or antiphospholipid syndrome independently established, suspected, or absent?","id":"lupus-and-antiphospholipid-evidence-q01","kind":"boundary"},{"text":"Which dated disease-activity assessments and antiphospholipid antibody results were available when the valve lesions were assessed?","id":"lupus-and-antiphospholipid-evidence-q02","kind":"provenance"}]}]},{"id":"infective-alternative","name":"Infective alternative","description":"Keep infective endocarditis, including unresolved culture-negative disease, visible in the differential.","findings":[{"id":"infection-evidence-and-residual-uncertainty","name":"Infection evidence and residual uncertainty","description":"Represent the evidence used to judge infection unlikely or supported rather than inferring sterility solely from a negative culture.","questions":[{"text":"What blood cultures and other indicated microbiological investigations were obtained, and did antibiotic exposure precede sampling?","id":"infection-evidence-and-residual-uncertainty-q01","kind":"provenance"},{"text":"What clinical, imaging, or tissue evidence supports infection, argues against it, or leaves culture-negative infection unresolved?","id":"infection-evidence-and-residual-uncertainty-q02","kind":"boundary"},{"text":"Which new findings would trigger prompt reassessment for concurrent or alternative infective endocarditis?","id":"infection-evidence-and-residual-uncertainty-q03","kind":"action"}]}]}]},{"id":"valve-and-embolic-consequences","name":"Valve and embolic consequences","description":"Assess functional valve effects and potentially related embolic injury.","layers":[{"id":"haemodynamic-effect","name":"Haemodynamic effect","description":"Determine whether the valve lesion impairs function and how strongly it explains clinical findings.","findings":[{"id":"valve-dysfunction-attribution","name":"Valve dysfunction attribution","description":"Record regurgitation or stenosis severity, supporting measurements, and competing causes of dysfunction.","questions":[{"text":"What regurgitation or stenosis grade and quantitative measurements accompany each affected valve?","id":"valve-dysfunction-attribution-q01","kind":"measurement"},{"text":"How strongly are symptoms or cardiac functional changes attributed to these lesions rather than another cardiac condition?","id":"valve-dysfunction-attribution-q02","kind":"boundary"}]}]},{"id":"embolic-consequences","name":"Embolic consequences","description":"Link neurological or systemic vascular events without assuming their source.","findings":[{"id":"event-to-valve-attribution","name":"Event-to-valve attribution","description":"An SLE study associated Libman-Sacks vegetations with cerebrovascular disease; individual event attribution still requires assessment of competing causes. [Embolic cerebrovascular study](https://pmc.ncbi.nlm.nih.gov/articles/PMC3941465/)","questions":[{"text":"Which suspected or established embolic events occurred, in what territories, and when relative to lesion detection?","id":"event-to-valve-attribution-q01","kind":"provenance"},{"text":"What evidence supports a valvular embolic source rather than antiphospholipid-related in situ thrombosis or another source?","id":"event-to-valve-attribution-q02","kind":"boundary"},{"text":"Do newly reported neurological or systemic ischaemic symptoms require urgent clinical assessment?","id":"event-to-valve-attribution-q03","kind":"action"}]}]}]},{"id":"course-and-clinical-review","name":"Course and clinical review","description":"Track lesion evolution and the evidence underlying condition-specific management decisions.","layers":[{"id":"longitudinal-comparison","name":"Longitudinal comparison","description":"Compare lesions and consequences across compatible examinations.","findings":[{"id":"lesion-evolution-and-residual-damage","name":"Lesion evolution and residual damage","description":"Track vegetation visibility and valve function separately, retaining uncertainty from changes in modality or image quality.","questions":[{"text":"Are the same anatomical lesions being compared using sufficiently comparable imaging techniques and measurement methods?","id":"lesion-evolution-and-residual-damage-q01","kind":"measurement"},{"text":"Have vegetation burden, valve dysfunction, and embolic events changed in the same or different directions?","id":"lesion-evolution-and-residual-damage-q02","kind":"measurement"},{"text":"Does a no-longer-visualised lesion represent convincing regression, limited detection, or an unresolved change?","id":"lesion-evolution-and-residual-damage-q03","kind":"boundary"}]}]},{"id":"management-decision-evidence","name":"Management decision evidence","description":"Represent clinician decisions and their indications without embedding an unsupported universal treatment algorithm.","findings":[{"id":"intervention-rationale-and-follow-up","name":"Intervention rationale and follow-up","description":"Link autoimmune treatment, antithrombotic treatment, valve intervention, and surveillance decisions to the specific problem they address.","questions":[{"text":"Which documented indication supports each treatment decision: autoimmune activity, an embolic event, independently established antiphospholipid syndrome, or valve dysfunction?","id":"intervention-rationale-and-follow-up-q01","kind":"action"},{"text":"Which patient-specific constraints and unresolved infection questions materially affect the proposed intervention?","id":"intervention-rationale-and-follow-up-q02","kind":"action"},{"text":"What clinician-defined follow-up interval, outcome measures, and escalation triggers apply, and what evidence supports them?","id":"intervention-rationale-and-follow-up-q03","kind":"provenance"}]}]}]},{"id":"evidence-and-external-alignment","name":"Evidence and external alignment","description":"What the world already says about this thing, gathered so the model can be checked against it.","layers":[{"id":"reported-evidence","name":"Reported evidence","description":"Findings from the breadth pass, kept separate from the structural claims.","findings":[{"id":"evidence-confidence-notes","name":"Check these first","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these check these first hold for the sense of Libman-Sacks endocarditis this model covers, and on what evidence?","id":"evidence-confidence-notes-q01","kind":"provenance"}]},{"id":"evidence-identifiers","name":"Identifiers and schemes","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these identifiers and schemes hold for the sense of Libman-Sacks endocarditis this model covers, and on what evidence?","id":"evidence-identifiers-q01","kind":"provenance"}]},{"id":"evidence-real-world-use","name":"Real-world use","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these real-world use hold for the sense of Libman-Sacks endocarditis this model covers, and on what evidence?","id":"evidence-real-world-use-q01","kind":"provenance"}]},{"id":"evidence-failure-modes-and-hazards","name":"Failure modes and hazards","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these failure modes and hazards hold for the sense of Libman-Sacks endocarditis this model covers, and on what evidence?","id":"evidence-failure-modes-and-hazards-q01","kind":"provenance"}]},{"id":"evidence-regional-variation","name":"Regional variation","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these regional variation hold for the sense of Libman-Sacks endocarditis this model covers, and on what evidence?","id":"evidence-regional-variation-q01","kind":"provenance"}]},{"id":"evidence-neighbours","name":"Neighbouring kinds and how to tell them apart","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these neighbouring kinds and how to tell them apart hold for the sense of Libman-Sacks endocarditis this model covers, and on what evidence?","id":"evidence-neighbours-q01","kind":"provenance"}]}]}]}]},"agentConduct":{"may":["Explain Libman-Sacks endocarditis and its links to lupus and antiphospholipid syndrome, citing medical sources.","Advise a person with lupus and new heart symptoms to contact their clinician."],"mustNot":["Diagnose the condition from symptoms or a report.","Advise starting or stopping anticoagulants or immune treatment.","Confuse it with infective endocarditis in a way that changes care.","Share a person's diagnosis or test results without consent."],"requiresHuman":["Any clinical decision about a person's heart valves or blood thinning."]},"ethics":{"considerations":["It can cause strokes; wrong advice on blood thinners can be fatal.","People with lupus often face disbelief about their symptoms."],"affectedParties":["People with lupus","People with antiphospholipid syndrome","Clinicians"]},"owners":{"steward":"Nobody owns the condition; clinicians answer for each patient's care.","roles":[],"masterSystems":[]},"relations":[{"target":"Q4826340","type":"parent","note":"registry parent class"},{"target":"Q73518","type":"parent","note":"registry parent class"}],"interaction":{"identity":{"applicability":"required","items":["Vercy registry: vr.tr.libman-sacks-endocarditis","Wikidata: Q1532243 (https://www.wikidata.org/wiki/Q1532243)"]},"properties":{"applicability":"not-applicable","items":["Diagnostic attribution: suspected | clinically supported | tissue-supported | disputed | excluded; assessor, date, and supporting evidence required","Associated autoimmune condition: Links to systemic lupus erythematosus and antiphospholipid syndrome assessments, including certainty and date","Valve and lesion distribution: Valve, leaflet or cusp, surface, attachment site, and number of lesions; unknown permitted","Vegetation dimensions: mm for reported dimensions; mm² for area if measured; examination date, modality, and measurement plane required","Lesion morphology: Reported shape, attachment breadth, mobility, echogenicity, and leaflet thickening","Infection assessment: not assessed | unresolved | infection considered unlikely | infection supported; microbiology and antibiotic exposure linked","Valve functional effect: Regurgitation and stenosis grades with grading standard, version, examination date, and quantitative support","Embolic event attribution: Linked event, territory, date, competing causes, and clinician-assessed attribution certainty","Longitudinal lesion state: newly detected | persistent | increased | decreased | no longer visualised | indeterminate; comparator examination required"]},"recognition":{"applicability":"not-applicable","items":[]},"capabilities":{"applicability":"required","items":["Assemble a traceable evidence summary supporting or challenging the Libman-Sacks attribution.","Identify missing infection assessments or imaging limitations that require clinical review.","Compare matched valve lesions across dated examinations.","Connect valve dysfunction and embolic events to their evidence and alternative explanations.","Prepare clinician review of monitoring, antithrombotic treatment, autoimmune treatment, or valve intervention using recorded indications and constraints."]},"hazards":{"applicability":"required","items":["Material from valve vegetations can embolize and cause stroke or injury to other organs.","Valve dysfunction can contribute to heart failure.","Confusion with infective endocarditis can delay appropriate clinical management."]},"interfaces":{"applicability":"required","items":["The International Classification of Diseases, issued by the World Health Organization, provides the official framework for coding this condition and its associated systemic disease."]},"context":{"applicability":"required","items":["This condition is encountered in clinical assessment of sterile heart valve lesions, particularly in people with systemic lupus erythematosus or antiphospholipid syndrome.","Its identification informs evaluation of valve function, embolic complications and possible alternative causes of endocarditis."]}},"sources":[{"title":"Wikidata item Q1532243: Libman–Sacks endocarditis","url":"https://www.wikidata.org/wiki/Q1532243","note":"identity and sense of the item"},{"title":"Wikipedia: Libman–Sacks endocarditis","url":"https://en.wikipedia.org/wiki/Libman%E2%80%93Sacks_endocarditis","note":"general description of the item"}],"openQuestions":["Which authoritative definition should govern this registry entry when sources differ over whether Libman-Sacks includes primary antiphospholipid syndrome-associated lesions or broader nonbacterial thrombotic endocarditis?","Is there a validated, generally accepted Libman-Sacks-specific diagnostic framework, and how should imaging-supported and tissue-supported diagnoses be distinguished without inventing criteria?","What are the verified ICD-10, jurisdiction-specific ICD-10 modification, ICD-11, and SNOMED CT mappings in named releases, and which require associated-disease coding?","What prevalence estimates are defensible by population, study year, age group, autoimmune diagnosis, and imaging or autopsy ascertainment method?","What evidence supports surveillance intervals and thresholds for antithrombotic treatment or valve intervention, particularly in asymptomatic patients without previous embolism?"],"resources":{"spec":"/models/things/publications/thing-q1532243/spec.json"},"provenance":{"origin":"thing registry research (pass 2)","builtFrom":["models/things/publications/thing-q1532243/spec.json"],"providers":["Codex"],"researchStatus":"unreviewed","generatedAt":"2026-09-12T10:57:33Z","builder":"tools/build_cards.py@1.0.0"},"completeness":{"sections":{"classifiers":"filled","whatItIs":"filled","purpose":"filled","distinguishingFeatures":"filled","structure":"filled","agentConduct":"filled","ethics":"filled","owners":"filled","relations":"filled","interaction.identity":"filled","interaction.properties":"not-applicable","interaction.recognition":"not-applicable","interaction.capabilities":"filled","interaction.hazards":"filled","interaction.interfaces":"filled","interaction.context":"filled","sources":"filled"},"notes":{"_gate":"Published through the thing publication gate 1.0 on 2026-10-07T10:10:26+00:00: completeness 1.00; sense: Wikidata description; 2 live sources; review by codex: pass","interaction.properties":"Plane INF: no invented physical properties.","interaction.recognition":"This internal disease has no reliable external visual signature and requires clinical assessment supported by diagnostic evidence."},"score":1.0}}