title: Cardiac involvement in antiphospholipid syndrome: The diagnostic role of noninvasive cardiac imaging.
abstract: OBJECTIVE
  The antiphospholipid syndrome (APS) is an autoimmune disorder of acquired hypercoagulability characterized by vascular thrombosis, increased pregnancy morbidity, and elevated levels of antiphospholipid antibodies. Cardiac involvement in APS may be presented as heart valve disease affecting approximately a third of patients or less frequently as intracardial thombosis, pulmonary hypertension, right or left ventricular dysfunction, micro-vascular thrombosis, coronary artery, or micro-vascular disease with overt or silent clinical presentation.
  
  
  METHODS
  Noninvasive cardiovascular imaging plays a crucial role in the evaluation of heart involvement in APS. Transthoracic or transoesophageal echocardiography enable early, accurate diagnosis and severity assessment of HVD as well as of ventricular dysfunction and pulmonary hypertension. Studies by echocardiography and nuclear imaging have detected abnormalities in myocardial perfusion in approximately 30% of primary APS. CT scan is the technique of choice for the assessment of pulmonary embolism and can effectively detect intracardiac thrombi. Myocardial perfusion defects have been detected by 13N-ammonia PET in 40% of APS. Cardiovascular magnetic resonance (CMR) has identified an unexpectedly high prevalence of occult myocardial scarring and endomyocardial fibrosis in APS, and is the technique of choice, if quantification of heart valve disease and stress myocardial perfusion-fibrosis is needed.
  
  
  RESULTS
  Noninvasive, nonradiating imaging techniques, such as echocardiography and CMR are superior to CT or nuclear techniques and are of great value for the diagnosis and follow-up of both clinically overt and silent cardiac disease in APS.
  
  
  CONCLUSIONS
  The high incidence of cardiac involvement in APS demands early diagnosis/treatment and multimodality cardiovascular imaging is of great importance.
authors.affiliation: Onassis Cardiac Surgery Center, Athens, Greece. Electronic address: soma13@otenet.gr.
authors.forename: Sophie I
authors.initials: SI
authors.lastname: Mavrogeni
authors.affiliation: First Department of Propeudeutic and Internal Medicine, Laikon Hospital, Athens University Medical School, Athens, Greece.
authors.forename: Petros P
authors.initials: PP
authors.lastname: Sfikakis
authors.affiliation: Arthritis Research UK Epidemiology Unit, Manchester University, Manchester, UK.
authors.forename: George D
authors.initials: GD
authors.lastname: Kitas
authors.affiliation: Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: Genovefa
authors.initials: G
authors.lastname: Kolovou
authors.affiliation: First Department of Internal Medicine, Rheumatology Unit, School of Medicine, University of Athens, Athens, Greece.
authors.forename: Maria G
authors.initials: MG
authors.lastname: Tektonidou
mesh_terms: D016736:Antiphospholipid Syndrome / Q000150:complications / Q000000981:diagnostic imaging*; D042241:Early Diagnosis; D004452:Echocardiography; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging; D012720:Severity of Illness Index
keywords: Antiphospholipid syndrome; Cardiovascular magnetic resonance imaging; Computed tomography; Echocardiography; Nuclear cardiology