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Cardiac manifestations of the antiphospholipid syndrome
S D Kaplan1, E K Chartash, R A Pizzarello
1Department of Medicine, North Shore University Hospital, Manhasset, NY 11030.
Insights
Antiphospholipid syndrome is linked to various heart problems, including valve disease, coronary artery disease, and cardiomyopathy. These findings highlight the significant role of antiphospholipid antibodies in cardiac pathology.
Area of Science:
- Cardiology
- Immunology
- Rheumatology
Background:
- Antiphospholipid syndrome (APS) is an autoimmune disorder.
- APS is characterized by the presence of antiphospholipid antibodies.
- APS is associated with an increased risk of thrombosis and pregnancy morbidity.
Purpose of the Study:
- To review the cardiac manifestations of APS.
- To discuss the proposed pathophysiologic mechanisms.
- To provide examples from clinical experience.
Main Methods:
- Literature review of cardiac manifestations in APS.
- Discussion of proposed pathophysiologic mechanisms.
- Presentation of case examples.
Main Results:
- APS is associated with valvular disease (verrucous endocarditis, thickening, insufficiency).
- APS is implicated in premature myocardial infarction and coronary artery bypass graft occlusion.
- Rare reports include intracardiac thrombi and diffuse cardiomyopathy.
Conclusions:
- The spectrum of cardiac disease in APS is expanding.
- Antiphospholipid antibodies play a significant role in certain cardiac pathologies.
- Further research is needed to elucidate the precise mechanisms.
Abstract:
The antiphospholipid syndrome has been associated with multiple cardiac abnormalities. The earliest reports were of valvular disease, including verrucous endocarditis, as well as valvular thickening and insufficiency. Subsequently, antiphospholipid antibodies were implicated in coronary artery disease manifested by premature myocardial infarction and coronary artery bypass graft occlusion. In addition, there have been rare reports of intracardiac thrombi and diffuse cardiomyopathy in association with antiphospholipid antibodies. In this review, we discuss the nature and prevalence of the cardiac manifestations of the antiphospholipid antibody syndrome as well as some of the proposed pathophysiologic mechanisms. We also provide examples from our own experience. The expanding spectrum of cardiac disease associated with antiphospholipid antibodies suggests an important role for these antibodies in certain types of cardiac pathology.