title: Myocardial Ischaemia, Coronary Atherosclerosis and Pulmonary Pressure Elevation in Antiphospholipid Syndrome Patients.
abstract: BACKGROUND
  Thrombotic events in antiphospholipid syndrome (APS) involve venous and arterial circulation with the possible involvement of coronary or pulmonary microcirculation.
  
  
  OBJECTIVE
  To evaluate the influence of antiphospholipid antibodies (aPL) and on myocardial ischaemia assessed by single-photon emission computerized tomography (SPECT), coronary atherosclerosis assessed by multidetector computerized tomography (MDCT) and pulmonary pressure assessed by transthoracic echocardiography (TTE) in patients with primary antiphospholipid syndrome (PAPS).
  
  
  METHODS
  TTE, SPECT (Tc 99m sestamibi) and MDCT-based coronary calcium scoring were performed in 26 consecutive PAPS patients (20 females, 6 males, aged 20-61, mean 39.7) without any signs of other autoimmunological disease and without clinical symptoms of heart disease.
  
  
  RESULTS
  Out of 26 patients, TEE showed normal left and right ventricle function in 25 (96.2%) and elevated (≥ 30 mm Hg) right ventricle systolic pressure in 7 (26.9%) patients. SPECT revealed myocardial perfusion defects in 15 (57.7%) patients: exercise-induced in 6 (23.1%) and persistent in 11 (42.3%). MDCT revealed coronary calcifications in 4 (15.4%) patients. The number of plaques ranged from 1 to 11 (median 2), volume 3-201.7 mm³ (median 7), calcium scores 1.3-202.6 (median 5.7). In the group with perfusion defects or coronary calcifications (n = 15), all the patients showed elevated aCL IgG.
  
  
  CONCLUSIONS
  In most of the relatively young APS patients, without any symptoms of ischemic heart disease, SPECT showed myocardial perfusion defects, and coronary calcifications in 1/6 of them. Right ventricle systolic pressure was elevated in 1/4 of APS patients. These pathologies, well known as cardiovascular risk markers, were associated with elevated levels of the IgG class of both anti-cardiolipin and antiB2 GPI antibodies. Thus, in a high percentage of APS patients, clinically silent myocardial ischaemia, pulmonary pressure elevation and coronary atherosclerosis are present and related to the presence of antiphospholipid antibodies.
authors.affiliation: Department of Internal Medicine, Allergy and Immunology, Jagiellonian University Medical College, Kraków, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Padjas
authors.affiliation: Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, Kraków, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Płazak
authors.affiliation: Department of Internal Medicine, Allergy and Immunology, Jagiellonian University Medical College, Kraków, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Celińska-Lowenhoff
authors.affiliation: Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, Kraków, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Mazurek
authors.affiliation: Rheumatology Unit, Department of Medicine, Sapienza University, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Perricone
authors.affiliation: Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, Kraków, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Podolec
authors.affiliation: Department of Internal Medicine, Allergy and Immunology, Jagiellonian University Medical College, Kraków, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Musiał
mesh_terms: D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000378:metabolism; D016736:Antiphospholipid Syndrome / Q000150:complications* / Q000503:physiopathology*; D050197:Atherosclerosis / Q000150:complications* / Q000503:physiopathology; D001794:Blood Pressure; D002118:Calcium / Q000378:metabolism; D003331:Coronary Vessels / Q000378:metabolism; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D016682:Lupus Coagulation Inhibitor / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D017202:Myocardial Ischemia / Q000150:complications* / Q000503:physiopathology*; D055414:Myocardial Perfusion Imaging; D013599:Systole; D015899:Tomography, Emission-Computed, Single-Photon; D055815:Young Adult
chemical_list: D017152:Antibodies, Antiphospholipid; D016682:Lupus Coagulation Inhibitor; D002118:Calcium
keywords: anti-beta 2 glycoprotein I antibodies; anti-cardiolipin antibodies; antiphospholipid syndrome; myocardial ischaemia; pulmonary arterial pressure