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Antiphospholipid Antibodies and Heart Failure with Preserved Ejection Fraction. The Multicenter ATHERO-APS Study

Daniele Pastori1, Paul R J Ames2,3, Massimo Triggiani4

  • 1Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, 00155 Rome, Italy.

Journal of Clinical Medicine
|July 24, 2021
PubMed

Insights

Heart failure with preserved ejection fraction (HFpEF) is present in 14.4% of antiphospholipid syndrome (APS) patients, particularly those with SLE. Antiphospholipid antibodies and hypertension are associated with HFpEF in APS.

Area of Science:

  • Cardiology
  • Rheumatology
  • Immunology

Background:

  • Antiphospholipid syndrome (APS) is an autoimmune disorder associated with an increased risk of thrombosis.
  • Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome characterized by diastolic dysfunction and elevated filling pressures.
  • The prevalence and characteristics of HFpEF in patients with APS remain largely unknown.

Purpose of the Study:

  • To determine the prevalence of HFpEF in patients with APS.
  • To identify clinical and serological factors associated with HFpEF in APS patients.

Main Methods:

  • A prospective multicenter cohort study included 125 patients with APS.
  • HFpEF diagnosis was based on the 2019 European Society of Cardiology criteria, including NT-ProBNP levels, left atrial enlargement, and increased left ventricular filling pressure.
  • Patients were categorized into primary APS (PAPS), APS with systemic lupus erythematosus (APS-SLE), and carriers.

Main Results:

  • Overall, 14.4% of APS patients were diagnosed with HFpEF.
  • The prevalence of HFpEF was higher in APS-SLE patients (27.8%) compared to PAPS (13.2%) and carriers (6.3%).
  • Factors associated with HFpEF included older age, hypertension, anticardiolipin antibodies IgG, anti-β2-glycoprotein-I IgG, lupus anticoagulants, and triple positivity.

Conclusions:

  • HFpEF is detectable in a significant proportion of APS patients.
  • The study highlights the association between specific antiphospholipid antibodies and HFpEF in APS.
  • Further research is needed to elucidate the role of antiphospholipid antibodies in the pathogenesis and prognosis of HFpEF in APS.
Abstract

Keywords:
HFpEFantiphospholipid syndromeechocardiographyheart failure

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