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Echocardiographic evaluation of patients with primary antiphospholipid syndrome
N Espínola-Zavaleta1, J Vargas-Barrón, T Colmenares-Galvis
1Department of Echocardiography, Instituto Nacional de Cardiología "Ignacio Chávez.", Mexico City, Mexico.
Insights
Primary antiphospholipid syndrome frequently causes valve disease. Anticoagulant or antiplatelet therapy did not improve existing valve lesions in patients with antiphospholipid syndrome.
Area of Science:
- Cardiology
- Rheumatology
- Internal Medicine
Background:
- Primary antiphospholipid syndrome (APS) is associated with a high prevalence of cardiac involvement, particularly valvular disease.
- Approximately 33-50% of patients with APS exhibit some form of valve compromise.
Purpose of the Study:
- To analyze echocardiographic features of APS-related heart disease.
- To evaluate the efficacy of anticoagulant and/or antiplatelet therapy in managing valvular lesions in APS patients over one year.
Main Methods:
- Transesophageal echocardiography (TEE) was used to assess valvular lesions in 29 APS patients before and after one year of treatment.
- Patients received anticoagulant and/or antiplatelet therapy (acetylsalicylic acid).
Main Results:
- Valvular lesions were detected in 75.9% of patients at baseline.
- After one year, TEE revealed no improvement in existing lesions in 46.2% of patients, while 53.8% developed new lesions.
- Associated cardiac issues included myocardial infarction and atrial septal defect.
Conclusions:
- Valvular disease is the primary cardiac manifestation of APS.
- Current anticoagulant/antiplatelet therapies do not appear to resolve or prevent the progression of noninfective valvular lesions in APS.
- APS can be linked to myocardial infarction even with normal coronary arteries.
Background:
A third to half of the patients with primary antiphospholipid syndrome have valve disease.
Methods And Results:
The echocardiographic characteristics of primary antiphospholipid syndrome were analyzed, and the utility of treatment with anticoagulants and/or antiplatelet agents (acetylsalicylic acid) is examined with the use of transesophageal echocardiography in the evaluation of valvular lesions after 1 year of therapy. Twenty-nine patients, 22 women and 7 men with average age of 35.4 years, were studied. Transesophageal echocardiography was performed on all patients before beginning anticoagulant and/or antiplatelet treatment. Valve lesions were found in 22 (75.9%) patients. Of these, other cardiac abnormalities were found in 3 cases, myocardial infarction in 2, and atrial septal defect in 1. In 7 (24.1%) cases, no valvular abnormality was detected, although in 1 of these, alterations in left ventricular segmental wall movement secondary to myocardial infarction were found. One year after initiation of anticoagulant and/or antiplatelet therapy, it was possible to perform transesophageal echocardiograms on 13 patients. No modification of valve lesions was found in 6 (46.2%) cases; new lesions had appeared in the remaining 7 (53.8%) as well as left ventricular apical akinesis in 1 case.
Conclusions:
These results indicate that the predominant heart lesion in primary antiphospholipid syndrome is valvular; anticoagulant and/or antiplatelet treatment does not diminish the noninfective valve lesions, and on occasion this entity may be associated with myocardial infarction despite angiographically normal coronary arteries.