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[Prevalence and description of cardiac involvements in primary antiphospholipid syndrome]
G Derumeaux1, C Lenormand, J Y Borg
1Service de cardiologie, hôpital de Bois-Guillaume.
Insights
Cardiac involvement is common in primary antiphospholipid syndrome (PAS). Echocardiography, particularly trans-esophageal echocardiography (TEE), effectively detects valvular heart disease and other cardiac manifestations in PAS patients.
Area of Science:
- Cardiology
- Rheumatology
- Immunology
Context:
- Primary antiphospholipid syndrome (PAS) is a condition associated with thromboembolism, recurrent abortion, antiphospholipid antibodies, and thrombocytopenia.
- Cardiac involvement is a potential complication of PAS, but its prevalence and characteristics require further elucidation.
- Previous studies have not comprehensively assessed cardiac involvement using advanced imaging techniques in PAS patients without systemic lupus erythematosus.
Purpose:
- To determine the prevalence of cardiac involvement in patients with primary antiphospholipid syndrome (PAS).
- To characterize the types of cardiac abnormalities present in PAS patients using transthoracic (TTE) and trans-esophageal echocardiography (TEE).
- To evaluate the diagnostic utility of TEE in identifying cardiac manifestations of PAS.
Summary:
- Transthoracic and trans-esophageal echocardiography were performed on 15 patients with PAS (mean age 38.8 years) without systemic lupus erythematosus.
- Valvular heart disease was detected in 60% of patients, including valve thickening and nodules. Regurgitation (mitral and aortic) was observed in several cases.
- Pericardial effusion occurred in 20% of patients. No abnormalities in left ventricular function were found. TEE proved sensitive for detecting valvular abnormalities, especially aortic valve issues.
Impact:
- Cardiac involvement, particularly valvular heart disease, is a frequent finding in primary antiphospholipid syndrome.
- Trans-esophageal echocardiography is a valuable tool for the accurate diagnosis and detailed assessment of cardiac abnormalities in PAS.
- These findings highlight the importance of cardiac screening in patients diagnosed with PAS to manage potential cardiovascular complications.
Abstract:
In order to assess the prevalence of cardiac involvement in the primary antiphospholipid syndrome (PAS), a syndrome which associates thromboembolism, recurrent abortion, the presence of antiphospholipid antibodies and thrombocytopenia, transthoracic (TTE) and trans-esophageal echocardiography (TEE) was performed in 15 patients, 10 women and 5 men with a mean age of 38.8 +/- 11 years, with the PAS but without systemic lupus erythematosus. The presentation of the PAS was a thrombotic event (6 arterial and 7 venous) in 13 cases, and recurrent abortion in 3 cases. Twelve patients had high anticardiolipin antibody levels (> or = 15 U GPL) and 12 had a raised anti-prothrombinase antibody title. Valvular heart disease was detected in 9 patients (60%) as a valve thickening (> or = 5 mm for the mitral and > or = 3 mm for the aortic valve) or nodule. Mitral regurgitation was observed in 4 cases both on TTE and TEE and was mild in 3 cases and severe in 1 case. Aortic regurgitation was diagnosed in 6 patients, in 3 cases by TTE and in 6 cases by TEE. It was mild in 5 cases and moderate in the other cases. Pericardial effusion was observed in 3 patients (20%), alone in 1 case and associated with valvular disease in the other two cases. No abnormality of left ventricular systolic or diastolic function could be demonstrated. In conclusion, cardiac involvement seems to be common in the PAS, and TEE is a sensitive and accurate method for describing the valvular, especially aortic valve, abnormalities.