title: Five-year follow-up by transesophageal echocardiographic studies in primary antiphospholipid syndrome.
abstract: This prospective study describes valvular abnormalities assessed by transesophageal echocardiography (TEE) in patients with primary antiphospholipid syndrome (APLS) over a 5-year follow-up. Of the 56 patients with APLS evaluated at baseline, 47 (84%) had repeat TEE examinations, including 3 patients who died before the end of the follow-up. The first TEE study showed cardiac involvement (thickening or vegetations and embolic sources) in 34 subjects (61%), with mitral valve thickening, the most common abnormality, present in 30 patients (54%). Embolic sources were found in 14 patients (25%; 9 severe spontaneous echocardiographic contrast, 5 Libman-Sacks endocarditis), associated with mitral valve thickening or stenosis in 10 patients. Over the 5-year follow-up, cardiac involvement was unchanged in 30 subjects (64%). New cardiac abnormalities were observed in 17 patients (36%), 15 (88%) with high immunoglobulin-G (IgG) anticardiolipin antibody (aCL) titers and 2 (12%) with low IgG aCL titers. In conclusion, this study showed that mitral valve thickening and embolic sources are frequently observed in patients with APLS. Anticoagulant and/or antiplatelet treatment was ineffective in terms of valvular lesion regression. New appearances of cardiac involvement are significantly related to high IgG aCL titers.
authors.affiliation: Department of Cardiology, Istituto Ortopedico Galeazzi, Italy. maurizio.turiel@unimi.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Turiel
authors.forename: Piercarlo
authors.initials: P
authors.lastname: Sarzi-Puttini
authors.forename: Rossana
authors.initials: R
authors.lastname: Peretti
authors.forename: Sara
authors.initials: S
authors.lastname: Bonizzato
authors.forename: Sabrina
authors.initials: S
authors.lastname: Muzzupappa
authors.forename: Fabiola
authors.initials: F
authors.lastname: Atzeni
authors.forename: Edoardo
authors.initials: E
authors.lastname: Rossi
authors.forename: Andrea
authors.initials: A
authors.lastname: Doria
mesh_terms: D000328:Adult; D000368:Aged; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D018450:Disease Progression; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D008946:Mitral Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D011247:Pregnancy; D011446:Prospective Studies; D012044:Regression Analysis; D015203:Reproducibility of Results; D012307:Risk Factors; D013923:Thromboembolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors