Five-year follow-up by transesophageal echocardiographic studies in primary antiphospholipid syndrome.
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.
Turiel
Maurizio
M
Department of Cardiology, Istituto Ortopedico Galeazzi, Italy. maurizio.turiel@unimi.it
Sarzi-Puttini
Piercarlo
P
Peretti
Rossana
R
Bonizzato
Sara
S
Muzzupappa
Sabrina
S
Atzeni
Fabiola
F
Rossi
Edoardo
E
Doria
Andrea
A
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