Related Experiment Videos
[Valvular heart disease in patients with anti-phospholipid syndrome]
F J Muñoz-Rodríguez1, J C Reverter Calatayud, J Font Franco
1Unidad de Enfermedades Autoinmunes Sistémicas. Hospital Clínic. Barcelona. Servicio de Medicina Interna. Hospital de Mollet. Barcelona. Spain. 28587fmr@comb.es
Insights
Valvular heart disease affects 19% of patients with anti-phospholipid syndrome (APS), commonly involving the mitral valve with insufficiency. Early echocardiograms are crucial for APS patients to detect and manage this complication.
Area of Science:
- Cardiology
- Immunology
- Rheumatology
Context:
- Anti-phospholipid antibodies (APA) are associated with various clinical manifestations, with valvular heart disease being a significant concern.
- Anti-phospholipid syndrome (APS) is an autoimmune disorder characterized by recurrent thrombosis and pregnancy morbidity, often involving multiple organ systems.
Purpose:
- To determine the prevalence and characteristics of valvular heart disease in patients with APS.
- To compare the clinical and immunological profiles of APS patients with and without valvular involvement.
Summary:
- A retrospective analysis of 113 APS patients revealed a 19% prevalence of valvular heart disease, predominantly mitral insufficiency.
- Patients with valvular involvement showed higher rates of thrombosis, stroke, thrombocytopenia, hemolytic anemia, and livedo reticularis.
- Immunologically, higher prevalence of lupus anticoagulant and anti-beta2 glycoprotein I (IgG) antibodies were observed in patients with valvular disease.
Impact:
- Highlights the significant prevalence of valvular heart disease in APS patients, emphasizing the need for cardiac evaluation.
- Suggests that valvular heart disease in APS is associated with a more severe thrombotic and immunological profile.
- Recommends routine echocardiographic assessment for APS patients during initial evaluation and follow-up to detect and manage valvular complications.
Introduction:
Anti-phospholipid antibodies (APA) may involve heart and valvular heart disease seems to be the most common clinical manifestation.
Objectives:
To study the prevalence and characteristics of valvular heart disease in a large patient population with anti-phospholipid syndrome (APS) and also to analyze the clinical and immunological profile of patients with valvular involvement compared with those without involvement. Patients and methods. Retrospective analysis of 113 patients diagnosed of APS. Eighty-one percent were females and the mean age was 39 years (SD:14). Sixty-two percent of patients were diagnosed of primary APS (70 patients) and the remaining 38% (43 patients) corresponded to patients with APS associated with systemic lupus erythematosus (SLE). The median follow-up of patients was 55 months (range: 7-144 months). The cardiologic assessment was performed by means of transthoracic echocardiogram. The study of anti-lupus anticoagulant (AL) was performed by means of coagulometric assays and measurement of anticardiolipin antibodies (aCL), anti-beta2 glycoprotein I (abeta2-PGI) and anti-prothrombin (aPT) by ELISA.
Results:
The prevalence of valvular heart disease was 19%. The mitral valve was mostly involved (91%) and the most common structural abnormality corresponded to mitral insufficiency. Valvular replacement was required in 24% of patients. In the subgroup of patients with valvular heart disease, a significantly higher prevalence was observed in the following parameters: total thrombosis (71% versus 49%; p = 0.05), arterial thrombosis (57% versus 23%; p = 0.002), stroke (38% versus 13%; p = 0.01), trombocitopenia (71% versus 45%; p = 0.02), hemolytic anemia (29% versus 9%; p = 0.02), and livedo reticularis (48% versus 3%; p < 0.0001). As for immunological differences, only a higher prevalence of LA was found (81% versus 59%; p= 0.04) and abeta2-GPI (IgG isotype) (43% versus 22%; p = 0.05) in patients with valvular heart disease.
Conclusions:
Valvular heart disease is more frequent in pa-tients with APS and mitral insufficiency is the most common lesion. In a patient with the diagnosis of APS, an echocar-digram should be obtained in his/her initial assessment and regular controls should be obtained in the follow-up.