title: Cardiac manifestations other than valvulopathy in antiphospholipid syndrome: long-time echocardiography follow-up study.
abstract: OBJECTIVE
  Non-valvular cardiac disease in the antiphospholipid syndrome (APS) has been scanty studied. We wanted to assess the prevalence and evolution of left myocardial disease, pulmonary hypertension and intracardiac thrombi in a cohort of APS patients.
  
  
  METHODS
  A total of 53 patients with APS, either primary (n = 34, 64%) or associated to lupus (n = 19, 36%) and 20 controls were included. Initial transthoracic echocardiography assessment was performed in patients at diagnosis, with echocardiography controls performed along mean follow-up of 12 years. Prevalence of myocardial disease in APS cohort was assessed taking into account primary risk factors (hemodynamically significant valvular disease, systemic hypertension, diabetes, alcoholism, myocardial infarction or myocarditis), the same as for pulmonary hypertension (severe left ventricular dysfunction or chronic lung disease).
  
  
  RESULTS
  Left myocardial disease had a prevalence of 3.8% (2/53 patients), not different from controls (P = 0.12). Both patients had diastolic dysfunction grade I that maintained stability throughout echocardiographic follow-up period. Pulmonary hypertension had a prevalence of 11.3% (6/53 patients), not different from controls (P = 0.12); all cases were related to pulmonary embolism. Patients diagnosed with pulmonary hypertension in baseline maintained stable pressures throughout follow-up in the absence of new thrombosis. Intracardiac thrombi had a prevalence of 1.8% (1/53 patients), not different from controls (P = 0.4), without changes along echocardiographic follow-up.
  
  
  CONCLUSIONS
  Pulmonary hypertension is the most prevalent non-valvular cardiac manifestation in APS, with an evolution associated with thromboembolic disease, while left myocardial disease and intracardiac thrombi would be rare manifestations in APS.
authors.affiliation: Research Unit for Autoimmune Diseases, Department of Internal Medicine, Vall d'Hebrón University Hospital, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Pardos-Gea
authors.forename: Gustavo
authors.initials: G
authors.lastname: Avegliano
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista
authors.forename: Miguel
authors.initials: M
authors.lastname: Vilardell
authors.forename: José
authors.initials: J
authors.lastname: Ordi-Ros
mesh_terms: D000328:Adult; D000368:Aged; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000453:epidemiology; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology; D055815:Young Adult
keywords: anti-phospholipid antibody syndrome; echocardiography; intracardiac thrombi; myocardial disease; pulmonary hypertension