Patients with primary antiphospholipid syndrome and coronary microvascular dysfunction--a distinct clinical subset.
Morbidity of patients with cardiac syndrome X (CSX) is high. Impairment of microvascular endothelial function has been suggested to be a mechanism of the disease. The study was undertaken to assess some of the characteristics of patients with primary antiphospholipid syndrome (pAPS) and CSX.


METHODS
We studied 36 patients with CSX, 14 patients having pAPS and 10 healthy controls. Patients evaluation included: clinical examination, 12-lead ECG, effort treadmill test (protocol Bruce modified), determination of plasma triglycerides, cholesterol, antiphospholipid antibodies (APLA). There were determined as markers of the inflammatory state: serum phospholipase (PL-A2) and peripheral neutrophils activity.


RESULTS
Patients with pAPS presented normal values of serum cholesterol and triglycerides levels, normal PL-A2 activity, moderate superoxide anion generation. Patients without APLA presented hyperlipidemia, increased PL-A2 activity, increased superoxide anion generation. During the follow-up period we found a correlation between P1-A2 activity and ischemic episodes, but only in patients with CSX and pAPS there were registered cardiovascular events.


CONCLUSIONS
Patients with SCX and pAPS represent a distinct clinical subset, being characterized by minimal inflammation, absence of usual risk factors for coronary heart disease, more severe prognosis related to recurrent thromboses and the need for early anticoagulant therapy.
Tănăseanu
Cristina
C
St. Pantelimon Clinical Emergency Hospital, Department of Internal Medicine, Bucharest, Romania.
Moldoveanu
Elena
E
Tănăseanu
St
S
Popescu
Monica
M
Dumitraşcu
Alina
A
Tamşulea
Isabela
I
Urban
Antoaneta
A
Grecu
Viorica
V
Neagu
Monica
M
Manea
Gabriela
G
Marta
Daciana
D
D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000097:blood; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D016022:Case-Control Studies; D002784:Cholesterol / Q000097:blood; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D017566:Microvascular Angina / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology; D010740:Phospholipases / Q000097:blood; D011379:Prognosis; D014280:Triglycerides / Q000097:blood
D017152:Antibodies, Antiphospholipid; D014280:Triglycerides; D002784:Cholesterol; D010740:Phospholipases