Cardiac manifestations in the antiphospholipid syndrome.
Experimental evidence reveals that aPL are not only markers of APS, but also may play a causative role in the development of vascular thrombosis and pregnancy morbidity. The pathogenic mechanisms of aPL seem to be heterogeneous, including endothelial cell activation, the direct inhibition of the activated protein C pathway, abnormalities in platelet function, and in complement activation. aPLs induce proadhesive, proinflammatory, and procoagulant molecules that provide a persuasive explanation for induction of thrombosis in APS. Cardiac manifestations in APS include valve abnormalities (valve thickening and vegetations), occlusive arterial disease (atherosclerosis and myocardial infarction), intracardiac emboli, ventricular dysfunction, and pulmonary hypertension. aPL may be associated with accelerated atherosclerosis in APS patients. Valve disease is the most important and most common cardiac manifestation of APS. The precise mechanism by which valves become deformed is not yet fully known.
Tenedios
Felicia
F
Hospital for Special Surgery, Department of Rheumatology, Weill Medical College of Cornell University, 535 East 70(th) Street, New York, NY 10021, USA. tenediosf@hss.edu
Erkan
Doruk
D
Lockshin
Michael D
MD
D017152:Antibodies, Antiphospholipid / Q000276:immunology; D016736:Antiphospholipid Syndrome / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D006321:Heart / Q000503:physiopathology; D006331:Heart Diseases / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D009206:Myocardium / Q000473:pathology; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care
D017152:Antibodies, Antiphospholipid