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Right ventricular diastolic dysfunction in patients with anticardiolipin antibodies and antiphospholipid syndrome
M G Tektonidou1, J P Ioannidis, I Moyssakis
1Department of Pathophysiology, University of Athens, School of Medicine, Athens, Greece.
Insights
Antiphospholipid syndrome (APS) is linked to right ventricular diastolic dysfunction, independent of other heart issues. This finding suggests a role for diastolic dysfunction in the syndrome's development.
Area of Science:
- Cardiology
- Rheumatology
- Immunology
Background:
- Antiphospholipid syndrome (APS) is an autoimmune disorder associated with an increased risk of thrombosis.
- Diastolic dysfunction, a condition affecting the heart's ability to relax and fill, has not been extensively studied in APS patients.
Purpose of the Study:
- To determine the prevalence of diastolic dysfunction in patients with anticardiolipin antibodies (aCL).
- To investigate if APS is independently associated with diastolic dysfunction, irrespective of valvular abnormalities or systolic dysfunction.
Main Methods:
- Doppler echocardiography was used to assess cardiac function in 164 subjects, including patients with primary APS, secondary APS (APS with SLE), SLE with aCL, SLE without aCL, and healthy controls.
- Exclusion criteria included systolic dysfunction or severe valvular disease.
Main Results:
- Significant differences in right ventricular function were observed across groups.
- A progressive worsening of diastolic function, indicated by prolonged deceleration time (DT) and isovolumic relaxation time (IVRT), was noted from SLE without aCL to primary APS.
- Primary APS and pulmonary hypertension were associated with increased DT, while IgG aCL titer predicted prolonged IVRT.
Conclusions:
- Diastolic dysfunction, particularly in the right ventricle, is a significant feature of APS.
- This dysfunction appears independent of valvular disease and systolic dysfunction, suggesting a potential role in the syndrome's pathogenesis.
Objective:
To evaluate the prevalence of diastolic dysfunction in patients with anticardiolipin antibodies (aCL) and to examine whether the antiphospholipid syndrome (APS) is associated with diastolic dysfunction independently of valvular abnormalities and systolic dysfunction.
Methods:
Pulsed, continuous, colour Doppler echocardiography was performed in 179 subjects, of whom 15 were excluded from the analysis because of systolic dysfunction or severe valvular disease. The remaining 164 subjects included 29 patients with primary APS, 26 patients with secondary APS (APS in the presence of systemic lupus erythematosus (SLE)), and 30 patients with SLE and aCL but without APS; 43 patients with SLE without aCL and 36 normal volunteers served as control groups.
Results:
The groups compared differed significantly in all measures of right ventricular function. There was a gradation of increasing diastolic function impairment as manifested by prolonged deceleration time (DT) and isovolumic relaxation time (IVRT) across the groups of patients with SLE without aCL, SLE with aCL, secondary APS, and primary APS. Differences in left ventricular diastolic function measures were less prominent. In regression analysis, DT increased by 19.6 ms (p=0.002) in the presence of primary APS and by 20.1 ms (p=0.038) in the presence of pulmonary hypertension. The titre of IgG aCL was the strongest predictor of a prolonged IVRT.
Conclusion:
Diastolic dysfunction, in particular of the right ventricle-that is, independent of valvular disease and systolic dysfunction, is a prominent feature of APS and may be related to the pathogenesis of the syndrome.