title: Asymptomatic myocardial ischemic disease in antiphospholipid syndrome: a controlled cardiac magnetic resonance imaging study.
abstract: OBJECTIVE
  Antiphospholipid syndrome (APS) may cause coronary thrombosis. This study was undertaken to determine the prevalence of silent myocardial disease in patients with APS, using late gadolinium enhancement (LGE) of cardiac magnetic resonance imaging (CMRI).
  
  
  METHODS
  Twenty-seven consecutive patients with APS and 81 control subjects without known cardiovascular disease underwent CMRI. The prevalence of occult myocardial ischemic disease, as revealed by LGE, was compared between patients with APS and controls, and factors associated with myocardial disease were identified in patients with APS.
  
  
  RESULTS
  Myocardial ischemic disease, as characterized by LGE on CMRI, was present in 8 (29.6%) of 27 patients with APS, and imaging with LGE showed a typical pattern of myocardial infarction (MI) in 3 patients (11.1%). The myocardial scarring revealed on CMRI was not detected by electrocardiography or echocardiography. Although both patients with APS and control subjects shared a low risk of cardiovascular events, as calculated with the Framingham risk equation (mean +/- SD 5.1 +/- 8.2% and 6.5 +/- 7.6%, respectively, for the absolute risk within the next 10 years; P = 0.932), the prevalence of myocardial ischemia was more than 7 times higher in patients with APS (P = 0.0006 versus controls). No association was found between myocardial disease in patients with APS and classic coronary risk factors. The presence of myocardial scarring tended to be more closely associated with specific features of APS, such as duration of the disease, presence of livedo, and positivity for anti-beta(2)-glycoprotein I antibodies.
  
  
  CONCLUSIONS
  The finding of a significant and unexpectedly high prevalence of occult myocardial scarring in patients with APS indicates the usefulness of CMRI with LGE for the identification of silent myocardial disease in such patients.
authors.affiliation: Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, and Paris 7 University, Paris, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Sacré
authors.forename: Benoit
authors.initials: B
authors.lastname: Brihaye
authors.forename: Fabien
authors.initials: F
authors.lastname: Hyafil
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Serfaty
authors.forename: Brigitte
authors.initials: B
authors.lastname: Escoubet
authors.forename: Maria-Christina
authors.initials: MC
authors.lastname: Zennaro
authors.forename: Olivier
authors.initials: O
authors.lastname: Lidove
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Laissy
authors.forename: Thomas
authors.initials: T
authors.lastname: Papo
mesh_terms: D000328:Adult; D016736:Antiphospholipid Syndrome / Q000175:diagnosis* / Q000453:epidemiology; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005602:France / Q000453:epidemiology; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D012307:Risk Factors
chemical_list: D005682:Gadolinium