Evaluation of cardiac abnormalities and embolic sources in primary antiphospholipid syndrome by transesophageal echocardiography.
OBJECTIVE
Valvular lesions are frequently present in Primary Antiphospholipid Syndrome (PAPS) patients using transthoracic and/or transesophageal echocardiography. The aim of this study was to describe the prevalence of cardiac abnormalities (valvular thickening and/or regurgitation) or potential embolic sources (spontaneous echocontrast and/or vegetations) in PAPS patients.


METHODS
Multiplane transesophageal echocardiography was performed consecutively on 40 PAPS PATIENTS: 17 of them with thrombocytopenia, 27 with at least one thromboembolic event (stroke, transient ischaemic attack, arterial and/or venous thrombosis, pulmonary embolism) and 14 with recurrent fetal loss.


METHODS
Cardiac involvement (cardiac abnormalities and/or embolic sources) was present in 33/40 (82%) of PAPS patients. According to aCL titer these lesions were revealed in 17/24 (71%) of patients with aCL < or = 40 GPL-U, while these lesions were present in 100% of patients with aCL > 40 GPL-U. Three patients presented mitral stenosis and 3 non-infective valve masses or vegetations. Embolic sources were found in 4/24 (17%) patients with aCL < or = 40 GPL-U, while they were observed in 6/16 (37%) of patients with titer of aCL > 40 GPL-U (chi2 = 10.03, P < 0.01). Regression analysis showed a positive correlation between mitral valve thickening and aCL antibodies titer (r = 0.5; P < 0.001).


CONCLUSIONS
Valvular lesions are commonly found in PAPS patients. Our data showed a significant correlation among aCL titer, mitral leaflets thickening and thromboembolic events.
Turiel
M
M
Internal Medicine II, L. Sacco Hospital, University of Milan, Italy. mauriziot@fisiopat.sacco.unimi.it
Muzzupappa
S
S
Gottardi
B
B
Crema
C
C
Sarzi-Puttini
P
P
Rossi
E
E
D000328:Adult; D000368:Aged; D016736:Antiphospholipid Syndrome / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology*; D017548:Echocardiography, Transesophageal; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged